Pregled komplikacija kirurških zahvata na štitnjači

The most obvious indication for thyroid surgery is malignancy, but other indications are also not rare. As with any other surgical procedure, those surgeries also carry risks which can be classified as minor or major. Discussion: In this overview, we present minor (seroma, scarring) and major complications of thyroid surgery (recurrent nerve injury, hypoparathyroidism, and bleeding). We discuss the possibilities of prevention and treatment of each of those complications. Conclusion: In recent years, thyroid surgery is becoming safer due to the development of new surgical, hemostatic, and other techniques such as intraoperative monitoring of the recurrent laryngeal nerve and parathyroid gland detection.Najočitija indikacija za kirurški zahvat na štitnjači je zloćudna novotvorina, ali nisu rijetke ni druge indikacije. Kao kod svake druge operacije i ovdje su mogući određeni rizici, koji se mogu podijeliti na blaže i teže. Rasprava: u ovom pregledu predstavljamo blaže (serom, ožiljke i disfagiju) i teže komplikacije kirurgije štitnjače (krvarenje, ozljeda povratnog živca i hipoparatiroidizam). Opisane su mogućnosti prevencije te liječenja svake pojedine komplikacije. Zaključak: u posljednje vrijeme kirurgija štitnjače postaje sve sigurnija, uz uvođenje novijih metoda hemostaze, kao i ostalih metoda poput intraoperativnog monitoringa povratnog živca i detekcije paratiroidnih žlijezda

Overview of 100 patients with voice prosthesis after total laryngectomy--experience of single institution [Pregled 100 bolesnika sa govornom protezom nakon totalne laringektomije]

Surgical procedures, especially total laryngectomy, used for treatment of advanced laryngeal carcinoma, have a profound adverse effect on the patient's physical, functional, and emotional health, and almost always decrease quality of life. There are three main types of voice rehabilitation after surgery. They are: esophageal speech techniques, the use of artificial larynx devices and tracheoesophageal puncture with the insertion of various types of voice prostheses. Voice prosthesis was inserted in 100 patients in the ENT Department, University Hospital Center Zagreb, from January 2004 until February 2011, and 91 of these patients were included in our study. The prosthesis was inserted secondary at 71 patients, while in other 20 it was inserted primary, i.e. immediately after laryngectomy as a part of the same procedure. Voice rehabilitation was initiated 10th day after primary insertion and 1st-3rd day after secondary insertion. The postoperative voice quality was compared with a five degree scale, which was taken from Hilger's retrospective study (2000). The rehabilitation was successful in 75.8% of our patients. Early complication rate was 4.4%, and 10.9% of patients had late complications. Statistical analysis didn't show significant differences regarding the complications rate and success rate of rehabilitation between groups of patients, formed according to age, irradiation status and timing of prosthesis insertion

Liječenje ranog karcinoma glotisa transoralnom endoskopskom laseskom kirurgijom

Laryngeal carcinoma is one of the most common tumors of the head and neck, just after skin cancer. Alongside open surgery, transoral endoscopic laser surgery (TOLS) has become widespread as a treatment method. Our aim was to assess the efficacy of transoral laser cordectomy in a group of patients with early glottic carcinoma. We retrospectively analyzed data on 131 patients who underwent TOLS in the 2017-2021 period. We divided patients into groups according to tumor stage and type of cordectomy performed, and compared outcomes between the groups. Our results revealed a higher number of patients in the group with Tis and T1a than in those with T1b and T2 who underwent type III cordectomy, and also a higher number of those for whom outpatient follow-ups were sufficient after surgery in the same group. We did not observe significant difference in outcomes according to cordectomy type except for type V (a-d), where a higher number of patients had to undergo radiotherapy. This study underlines the importance of careful patient selection for TOLS, as well as the need for close cooperation with pathology and radiology specialists to ensure optimal approach and extent of surgery for each individual patient. It also displayed TOLS as a sound therapeutic option for early stages of glottic carcinoma but also indicated the need for similar studies in a larger number of patients to elucidate the effectiveness in certain glottis areas.Karcinom grkljana ubraja se u najčešće tumore u području glave i vrata, odmah nakon kožnih zloćudnih tumora. Uz otvorene kirurške metode transoralna endoskopska laserska kirurgija je postala vrlo rasprostranjena kao metoda liječenja. Cilj našeg istraživanja bio je utvrditi kolika je uspješnost laserske kordektomije u liječenju bolesnika oboljelih od ranog karcinoma grkljana. U ovoj retrospektivnoj studiji analizirali smo podatke 131 bolesnika koji su podvrgnuti endoskopskoj laserskoj kirurgiji glasnica zbog karcinoma u razdoblju od 2017. do 2021. godine. Bolesnici su podijeljeni u skupine s obzirom na stadij tumora te tip učinjene kordektomije te smo usporedili ishode među skupinama. Rezultati su prikazali veći broj bolesnika s tumorima Tis i T1a (skupinaa A) nego onih s T1b i T2 (skupina B) kojima je učinjena kordektomija tip III. te također veći broj onih kojima su dostatne bile ambulantne kontrole u skupini A. Nije uočena značajna razlika u ishodima s obzirom na tip učinjene kordektomije osim za tip V (a-d), gdje je veći broj bolesnika kasnije podvrgnut radioterapiji. Ovo istraživanje ukazalo je na važnost pažljivog izbora bolesnika koji su kandidati za transoralnu lasersku resekciju te nužnost bliske suradnje sa specijalistima radiologije i patologije, kako bi se osigurao optimalan pristup i opseg za svakog bolesnika. Također dokazuje kako je transoralna laserska resekcija pouzdana terapijska opcija za rane stadije karcinoma glotisa te upućuje na važnost provođenja sličnih istraživanja s većim brojem bolesnika kako bi se rasvijetlila uspješnost ove metoda u određenim dijelovima glotisa

Our Experience with Virtual Endoscopy of Paranasal Sinuses

The main goal of our work was to evaluate advantages and disadvantages of virtual endoscopy (VE) techniques in routinely diagnostic and preoperative management of patients with various sinus diseases or head traumas in our practice. Fly-through algorithm was performed using an Xeon based workstation on data sets created from axial CT images acquired from 320 patients with various paranasal sinus disorders. Images were created using Siemens Somatom Emotion 16 continiously rotating helical CT scanner and archived in DICOM format. In comparison with real endoscopy, the VE has several advantages. It is completely non-invasive. It is possible to repeat the same procedure several times, therefore it may be a valuable tool for training. Interactive control of all virtual camera parameters, including the field- -of-view is possible. Endoscopic viewing as opposed to real endoscopy is not restricted to the spaces defined by inner surfaces. The viewer may penetrate the walls and see the extent of lesions within and beyond the wall as well as the adjacent anatomic structures. Virtual endoscopy also has a potential to stage tumors by determining the location and the extent of transmural extension

Smjernice za nepoznati primarni karcinom glave i vrata

Kod 3-5% metastatskih karcinoma glave i vrata se ne otkrije primarni tumor, ni nakon široke dijagnostičke obrade. Taj udio je sve manji upotrebom modernijih dijagnostičkih metoda kao što su MSCT i PET-CT, te narrow band imaging kod fiberskopije. Usporedno s ovim mijenjaju se i postupnici u dijagnostici i liječenju. Sve više autora preporučuje obostranu tonzilektomiju, a prije raširene slijepe biopsije sve se više napuštaju

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

Overview of 100 Patients with Voice Prosthesis after Total Laryngectomy – Experience of Single Institution

Surgical procedures, especially total laryngectomy, used for treatment of advanced laryngeal carcinoma, have a profound adverse effect on the patient’s physical, functional, and emotional health, and almost always decrease quality of life. There are three main types of voice rehabilitation after surgery. They are: esophageal speech techniques, the use of artificial larynx devices and tracheoesophageal puncture with the insertion of various types of voice prostheses. Voice prosthesis was inserted in 100 patients in the ENT Department, University Hospital Center Zagreb, from January 2004 until February 2011, and 91 of these patients were included in our study. The prosthesis was inserted secondary at 71 patients, while in other 20 it was inserted primary, i.e. immediately after laryngectomy as a part of the same procedure. Voice rehabilitation was initiated 10th day after primary insertion and 1st–3rd day after secondary insertion. The postoperative voice quality was compared with a five degree scale, which was taken from Hilger’s retrospective study (2000). The rehabilitation was successful in 75.8% of our patients. Early complication rate was 4.4%, and 10.9% of patients had late complications. Statistical analysis didn’t show significant differences regarding the complications rate and success rate of rehabilitation between groups of patients, formed according to age, irradiation status and timing of prosthesis insertion

Application of Novel Lossless Compression of Medical Images Using Prediction and Contextual Error Modeling

Conduction of tele-3D-computer assisted operations as well as other telemedicine procedures often requires highest possible quality of transmitted medical images and video. Unfortunately, those data types are always associated with high telecommunication and storage costs that sometimes prevent more frequent usage of such procedures. We present a novel algorithm for lossless compression of medical images that is extremely helpful in reducing the telecommunication and storage costs. The algorithm models the image properties around the current, unknown pixel and adjusts itself to the local image region. The main contribution of this work is the enhancement of the well known approach of predictor blends through highly adaptive determination of blending context on a pixel-by-pixel basis using classification technique. We show that this approach is well suited for medical image data compression. Results obtained with the proposed compression method on medical images are very encouraging, beating several well known lossless compression methods. The predictor proposed can also be used in other image processing applications such as segmentation and extraction of image regions

Application of Novel Lossless Compression of Medical Images Using Prediction and Contextual Error Modeling

Conduction of tele-3D-computer assisted operations as well as other telemedicine procedures often requires highest possible quality of transmitted medical images and video. Unfortunately, those data types are always associated with high telecommunication and storage costs that sometimes prevent more frequent usage of such procedures. We present a novel algorithm for lossless compression of medical images that is extremely helpful in reducing the telecommunication and storage costs. The algorithm models the image properties around the current, unknown pixel and adjusts itself to the local image region. The main contribution of this work is the enhancement of the well known approach of predictor blends through highly adaptive determination of blending context on a pixel-by-pixel basis using classification technique. We show that this approach is well suited for medical image data compression. Results obtained with the proposed compression method on medical images are very encouraging, beating several well known lossless compression methods. The predictor proposed can also be used in other image processing applications such as segmentation and extraction of image regions

Praćenje bolesnika s karcinomom grkljana nakon završetka liječenja

SAŽETAK Praćenje bolesnika s karcinomom grkljana smatra se važnim dijelom postupka njihova liječenja. Glavna je svrha praćenja, osim procjene učinkovitosti terapije i rehabilitacije, rano otkrivanje potencijalnog recidiva i drugoga primarnog tumora. Trenutno i dalje nema točnih smjernica i preporuka temeljenih na konkretnim podatcima o razlikama u preživljenju. Svrha je ovog prikaza sabrati trenutne preporuke i postavke temeljene na recentnim podatcima iz literature te na kliničkom iskustvu naše ustanove. Učinjen je pregled literature o praćenju i rehabilitaciji bolesnika s karcinomom grkljana. Naše su tvrdnje temeljene na kritičkom razmatranju trenutačnih podataka iz literature i kliničke prakse. Procjena stadija karcinoma temeljena je na trenutnoj UICC-ovoj (engl. Union for International Cancer Control) TNM klasifikaciji karcinoma grkljana. Sastavnice praćenja obrađene u ovom prikazu uključuju duljinu praćenja, učestalost i organizaciju pregleda te radiološke pretrage s obzirom na vrstu terapije (kirurška/radioterapija). Jedan od najvažnijih dijelova praćenja jest edukacija bolesnika o prepoznavanju znakova i simptoma potencijalnog recidiva ili drugoga primarnog tumora. Potrebno je provesti opsežne prospektivne i retrospektivne studije kako bi se propisno ocijenilo trenutne preporuke i smjernice o praćenju s obzirom na stope preživljenja