Rehabilitacija glasa kod laringektomiranih bolesnika s ugrađenom govornom protezom; Možemo li doseći 100%?

Cilj rada: Uspješnost glasovne rehabilitacije nakon totalne laringektomije varira, ovisno o studiji, od 70 do 95%.Psihološki efekt nemogućnosti govora kod laringektomiranih bolesnika je velik. Početni neuspjeh govorne rehabilitacije s vremenom vodi do stvaranja pogrešnih fonacijskih mehanizama, frustriranosti i deprimiranosti. Cilj rada je dokazati da rana intervencija botulinum toksinom vodi povećanom postotku rehabilitacije. Materijali i metode: U zadnje tri godine u našem centru učinjene su 64 laringektomije. Kod većine bolesnika (61) učinjena je primarna traheoezofagealna fistulizacija i ugradnja govorne proteze. Kod svih bolesnika logopedska govorna rehabilitacija započeta je rano, uglavnom oko četrnaestog postoperativnog dana. Osam bolesnika imalo je izrazito loš glas ili nemogućnost govora; hipertonicitet je detektiran kao osnovni uzrok. Uz osam navedenih, učinili smo intervenciju kod još četiri bolesnika iz drugih ustanova. Za razliku od uvriježenog postupnika intenziviranja logopedske terapije i ekspektativnog stava, odmah po obradi započeli smo s intervencijom. Hipertonicitet je potvrđen lidokainskim testom. Svakom bolesniku aplicirano je ukupno 100j botulinum toksina tip A, odnosno u dva navrata po 50j u razmaku od 7-21dana. Mjesto aplikacije određeno je palpacijski, a kod jednog bolesnika ultrazvučno (izrazit edem).Lijek se injektira u šest do osam pojedinačnih mjesta. Nismo zabilježili nuspojava aplikacije. Govor je procijenjen pred drugu aplikaciju te mjesec dana po drugoj aplikaciji. Impakt rane intervencije procijenili smo VHI (voice handicap index) i VRQOL (voice-related quality of life) upitnicima, te akustičnim parametrima. Rezultati: Svi bolesnici tretirani botulinum toksinom odgovorili su već na prvu dozu, svi su zadržali kvalitetu glasa u dosadašnjem praćenju i nije bilo potrebe za ponovnom intervencijom botulinum toksinom. Zaključak: Rana intervencija kod laringektomiranih bolesnika s urađenom govornom protezom i nemogućnosti (dostatnog) govora, po našem iskustvu osigurava odlične rezultate kod svih (selektiranih) bolesnika. Sama metoda nema značajnih nuspojava niti komplikacija kod pažljive primjene.Ovakvim pristupom nadmašili smo dosadašnje postotke uspješnosti govora kod laringektomiranih s govornom protezom

Rehabilitacija glasa kod laringektomiranih bolesnika s ugrađenom govornom protezom; Možemo li doseći 100%?

Cilj rada: Uspješnost glasovne rehabilitacije nakon totalne laringektomije varira, ovisno o studiji, od 70 do 95%.Psihološki efekt nemogućnosti govora kod laringektomiranih bolesnika je velik. Početni neuspjeh govorne rehabilitacije s vremenom vodi do stvaranja pogrešnih fonacijskih mehanizama, frustriranosti i deprimiranosti. Cilj rada je dokazati da rana intervencija botulinum toksinom vodi povećanom postotku rehabilitacije. Materijali i metode: U zadnje tri godine u našem centru učinjene su 64 laringektomije. Kod većine bolesnika (61) učinjena je primarna traheoezofagealna fistulizacija i ugradnja govorne proteze. Kod svih bolesnika logopedska govorna rehabilitacija započeta je rano, uglavnom oko četrnaestog postoperativnog dana. Osam bolesnika imalo je izrazito loš glas ili nemogućnost govora; hipertonicitet je detektiran kao osnovni uzrok. Uz osam navedenih, učinili smo intervenciju kod još četiri bolesnika iz drugih ustanova. Za razliku od uvriježenog postupnika intenziviranja logopedske terapije i ekspektativnog stava, odmah po obradi započeli smo s intervencijom. Hipertonicitet je potvrđen lidokainskim testom. Svakom bolesniku aplicirano je ukupno 100j botulinum toksina tip A, odnosno u dva navrata po 50j u razmaku od 7-21dana. Mjesto aplikacije određeno je palpacijski, a kod jednog bolesnika ultrazvučno (izrazit edem).Lijek se injektira u šest do osam pojedinačnih mjesta. Nismo zabilježili nuspojava aplikacije. Govor je procijenjen pred drugu aplikaciju te mjesec dana po drugoj aplikaciji. Impakt rane intervencije procijenili smo VHI (voice handicap index) i VRQOL (voice-related quality of life) upitnicima, te akustičnim parametrima. Rezultati: Svi bolesnici tretirani botulinum toksinom odgovorili su već na prvu dozu, svi su zadržali kvalitetu glasa u dosadašnjem praćenju i nije bilo potrebe za ponovnom intervencijom botulinum toksinom. Zaključak: Rana intervencija kod laringektomiranih bolesnika s urađenom govornom protezom i nemogućnosti (dostatnog) govora, po našem iskustvu osigurava odlične rezultate kod svih (selektiranih) bolesnika. Sama metoda nema značajnih nuspojava niti komplikacija kod pažljive primjene.Ovakvim pristupom nadmašili smo dosadašnje postotke uspješnosti govora kod laringektomiranih s govornom protezom

"It All Ended in an Unsporting Way": Serbian Football and the Disintegration of Yugoslavia, 1989-2006

Part of a wider examination into football during the collapse of Eastern European Communism between 1989 and 1991, this article studies the interplay between Serbian football and politics during the period of Yugoslavia's demise. Research utilizing interviews with individuals directly involved in the Serbian game, in conjunction with contemporary Yugoslav media sources, indicates that football played an important proactive role in the revival of Serbian nationalism. At the same time the Yugoslav conflict, twinned with a complex transition to a market economy, had disastrous consequences for football throughout the territories of the former Yugoslavia. In the years following the hostilities the Serbian game has suffered decline, major financial hardship and continuing terrace violence, resulting in widespread nostalgia for the pre-conflict era

PO-410 Cytotoxicity and genotoxicity of new gadolinium, iron oxide, cobalt ferrite and graphene oxide nanoparticles on some tumour cell lines in vitro

Nanoparticles (NPs) are increasingly used in cancer therapy as delivery agents and in the diagnosis of malignant diseases as contrast agents for magnetic resonance imaging (MRI). The aim of this work was in vitro assessments of Gd-NPs, Fe- NPs, CoFe-NPs and Graphene Oxide-NPs cytotoxicity and genotoxicity on some tumour and normal human cell lines.Abstracts of the 25th Biennial Congress of the European Association for Cancer Research, Amsterdam, The Netherlands, 30 June – 3 July 201

Analytical techniques for multiplex analysis of protein biomarkers

Introduction: The importance of biomarkers for pharmaceutical drug development and clinical diagnostics is more significant than ever in the current shift toward personalized medicine. Biomarkers have taken a central position either as companion markers to support drug development and patient selection, or as indicators aiming to detect the earliest perturbations indicative of disease, minimizing therapeutic intervention or even enabling disease reversal. Protein biomarkers are of particular interest given their central role in biochemical pathways. Hence, capabilities to analyze multiple protein biomarkers in one assay are highly interesting for biomedical research. Areas covered: We here review multiple methods that are suitable for robust, high throughput, standardized, and affordable analysis of protein biomarkers in a multiplex format. We describe innovative developments in immunoassays, the vanguard of methods in clinical laboratories, and mass spectrometry, increasingly implemented for protein biomarker analysis. Moreover, emerging techniques are discussed with potentially improved protein capture, separation, and detection that will further boost multiplex analyses. Expert commentary: The development of clinically applied multiplex protein biomarker assays is essential as multi-protein signatures provide more comprehensive information about biological systems than single biomarkers, leading to improved insights in mechanisms of disease, diagnostics, and the effect of personalized medicine

The politics of performance: transnationalism and its limits in former Yugoslav popular music, 1999–2004

This paper examines transnational relations between the Yugoslav successor states from the point of view of popular music, and demonstrates how transnational musical figures (such as Djordje Balaševi?, Mom?ilo Bajagi?-Bajaga and Ceca Ražnatovi?) are interpreted as symbolic reference points in national ethnopolitical discourse in the process of identity construction. Another symbolic function is served by Serbian turbofolk artists, who in Croatia serve as a cultural resource to distance oneself from a musical genre associated by many urban Croats with the ruralization (and Herzegovinization) of Croatian city space. In addition, value judgements associated with both Serbian and Croatian newly composed folk music provide an insight into the transnational negotiation of conflicting identities in the ex-Yugoslav context. Ultimately the paper shows how the ethnonational boundaries established by nationalizing ideologies created separate cultural spaces which themselves have been transnationalized after Yugoslavia's disintegration

Long-term results of treatment of injuries to the sectoral and segmental bile ducts

INTRODUCTION Surgically important variations of the sectoral and segmental bile ducts of the right lobe of the liver appear in a significant proportion of patients. Frequency of the injuries to these ducts is not known as the ligature of small ducts may pass without major consequences. MATERIAL AND METHODS Over a 27 year period (1. Jan 1974-31. Dec 2001) along with 168 patients with benign biliary strictures of type I, II, III and IV according to Bismuth's classification, we treated 13 patients with operative sectoral or segmental bile duct injuries, four patients from our institution and nine patients transferred from elsewhere. The injury was recognized at original surgery in all four patients operated in our institution. Primary repair was performed in three patients, in two patients direct end-to-end repair overT-tube and in one patient with anastomosis between the injured duct and Roux-en-Y jejunal limb, while in one patient the injured duct was ligated. In no one of nine patients transferred from elsewhere the injury was recognized during original surgery. Four patients were sent with biliary peritonitis, another four patients with external biliary fistula and one patient for pain and fever due to liver abscess. RESULTS All three patients in whom the primary repair was performed had a quick and uneventful recovery and they stayed symptom-free so far. The patient in whom the injured duct was ligated died after series of complications. Four patients sent to us with biliary peritonitis were treated with relaparotomy, lavage and drainage and all developed external biliary fistula. Three of these patients had their fistula ceased spontaneously within few weeks, while in one patient the fistula didn't show signs of ceasing so that injured duct had to be anastomosed with Roux-en-Y jejunal limb. Two out of four patients sent for external biliary fistula had it ceased spontaneously, while in two patients anastomosis between duct and Roux-en-Y jejunal limb was necessary. The last 13th patient, who had sectoral duct severed and ligated was reoperated liver abscess drained and duct anastomosed with Roux-en-Y jejunal limb. That patient developed an anastomotic stricture a year later and he was successfully reoperated and stayed symptom-free so far. All 12 patients have been followed up from nine months to 27 years (average 9.2 years) and neither developed biliary symptoms. CONCLUSION We conclude that the management of these injuries depends upon the time of recognition of the lesion, size of the injured duct and of the type and stage of complications