Transoral Excision of a Parapharyngeal Space Tumor: Case Report

Tumors of the parapharyngeal space are rare tumors comprising less than 1% of all head and neck neoplasms. They are mainly salivary gland or neurogenic tumors. Clinical presentation is very variable. Surgical resection by different approaches remains to be the best possible treatment option. We present a case of 45 years old female patient admitted at the ENT Department due to the unilateral hearing loss and swallowing difficulties. Clinical examination revealed the diagnosis of a pleomorphic adenoma of the parapharyngeal space. Tumor was surgical (transorally) excised. Two years following the surgery there is no recurrence of the initial symptoms and primary disease

Transoral Excision of a Parapharyngeal Space Tumor: Case Report

Tumors of the parapharyngeal space are rare tumors comprising less than 1% of all head and neck neoplasms. They are mainly salivary gland or neurogenic tumors. Clinical presentation is very variable. Surgical resection by different approaches remains to be the best possible treatment option. We present a case of 45 years old female patient admitted at the ENT Department due to the unilateral hearing loss and swallowing difficulties. Clinical examination revealed the diagnosis of a pleomorphic adenoma of the parapharyngeal space. Tumor was surgical (transorally) excised. Two years following the surgery there is no recurrence of the initial symptoms and primary disease

Dermatoglyphs and Larynx Cancer

Cancer of the larynx is the seventh most common malignant disease among middle-aged men in Croatia. Morbidity ratio between men and women is 17:1. Etiology of disease is directly connected with the tobacco use while genetic influences have not yet been studied enough. Digito-palmar dermatoglyphs analysis has already been used in studying the genetic etiology of certain malignant diseases (lung, breast, cervical, colorectal, melanoma and gastric cancer). We have analyzed correlation of quantitative and qualitative traits between two groups (group of 40 men with larynx cancer versus control group of 100 phenotypically healthy men). Quantitative statistical analysis (descriptive statistics, multivariate and univariate analysis) has not shown statistically significant difference except for the latent structure using factor analysis. Qualitative analysis has shown statistically significant difference among two investigated groups thus suggesting the faster changes of the qualitative features under the influence of the ecological factors

Nefunkcio nalni karcinom paratiroidne žlijezde : prikaz slučaja

Parathyroid gland carcinoma is a rare malignancy. The tumor is mostly functioning, causing severe hyperparathyroidism, with high serum calcium level and severe bone disease. Non-functioning parathyroid carcinomas are extremely rare. We report on a 60-year-old male patient admitted to ENT Department due to a large neck tumor mass compressing the thyroid and trachea. Preoperatively, thyroid hormone, parathyroid hormone (PTH ) and calcium serum levels were normal. The following immunohistochemical markers (DAKO, Denmark) were used: bcl-2; CD- 10; Chromogranin-A; Cyclin-D1; EM A; Ki-67; Mdm-2; p-53; PGP-9,5; RCC; Synaptophysin; Thyroglobulin; and TTF -1. Immunohistochemical analysis indicated the diagnosis of a primary parathyroid gland carcinoma. Tumor cells showed diffusely positive immunohistochemical staining with chromogranin-A and PGP-9,5, positive staining of variable intensity with synaptophysin, and weakly positive reaction with EM A. Also, the cytoplasm of tumor cells was diffusely positively stained with bcl-2, while the nuclei showed positive reaction with p-53 oncogene and TTF -1. The remaining markers (CD-10, cyclin-D1, Ki-67, Mdm-2, RCC and thyroglobulin) were negative. Four years after the surgery, the patient died from renal carcinoma pulmonary metastases and liver cirrhosis complications. In conclusion, non-functioning parathyroid gland carcinoma is a very rare disease. Detailed immunohistochemical analysis is needed to distinguish it from other thyroid and parathyroid neoplasms and metastatic carcinoma. Surgical treatment is presently the best mode of therapy.Karcinom paratiroidne žlijezde je rijedak maligni tumor. Tumor je najčešće hormonski aktivan i uzrokuje teški oblik hiperparatiroidizma s visokom serumskom razinom kalcija, poremećajima koštane gustoće i bubrežnim kamencima. Nefunkcionalni paratiroidni karcinom je iznimno rijedak. Prikazuje se slučaj 60-godišnjeg bolesnika koji je primljen na Odjel otorinolaringologije zbog velikog tumora vrata koji je komprimirao grkljan i dušnik. Prijeoperacijski su serumske vrijednosti hormona štitnjače, paratiroidnog hormona i kalcija bile unutar referentnih vrijednosti. Korišteni su slijedeći imunohistokemijski biljezi: (DAKO, Danska): bcl-2; CD-10; Chromogranin-A; Cyclin-D1; Ki-67; Mdm-2; p-53; RCC; Synaptophysin; Thyroglobulin i TTF -1. Imunohistokemijskom analizom tumora postavljena je dijagnoza primarnog karcinoma paratiroidne žlijezde. Tumorske stanice su pokazale difuzno pozitivnu imunoreakciju s kromograninom i PGP- 9,5, pozitivnu reakciju različitog intenziteta sa sinaptofizinom, te slabo pozitivnu reakciju na EM A. U citoplazmi je nađena umjereno pozitivna reakcija na bcl-2, a jezgre su bile pozitivne na p-53 i TTF -1, dok su ostali biljezi bili nereaktivni. Četiri godine nakon operacije bolesnik je umro od posljedica plućnih metastaza karcinoma bubrega i dekompenzirane jetrene ciroze. U zaključku, nefunkcionalni karcinom paratiroidne žlijezde je vrlo rijedak i težak za dijagnosticiranje. Detaljnim imunohistokemijskim metodama potrebno ga je diferencirati od ostalih tumora štitne i paratiroidne žlijezde i metastatskog karcinoma. Kirurško liječenje danas predstavlja optimalan oblik terapije

Nefunkcio nalni karcinom paratiroidne žlijezde : prikaz slučaja

Parathyroid gland carcinoma is a rare malignancy. The tumor is mostly functioning, causing severe hyperparathyroidism, with high serum calcium level and severe bone disease. Non-functioning parathyroid carcinomas are extremely rare. We report on a 60-year-old male patient admitted to ENT Department due to a large neck tumor mass compressing the thyroid and trachea. Preoperatively, thyroid hormone, parathyroid hormone (PTH ) and calcium serum levels were normal. The following immunohistochemical markers (DAKO, Denmark) were used: bcl-2; CD- 10; Chromogranin-A; Cyclin-D1; EM A; Ki-67; Mdm-2; p-53; PGP-9,5; RCC; Synaptophysin; Thyroglobulin; and TTF -1. Immunohistochemical analysis indicated the diagnosis of a primary parathyroid gland carcinoma. Tumor cells showed diffusely positive immunohistochemical staining with chromogranin-A and PGP-9,5, positive staining of variable intensity with synaptophysin, and weakly positive reaction with EM A. Also, the cytoplasm of tumor cells was diffusely positively stained with bcl-2, while the nuclei showed positive reaction with p-53 oncogene and TTF -1. The remaining markers (CD-10, cyclin-D1, Ki-67, Mdm-2, RCC and thyroglobulin) were negative. Four years after the surgery, the patient died from renal carcinoma pulmonary metastases and liver cirrhosis complications. In conclusion, non-functioning parathyroid gland carcinoma is a very rare disease. Detailed immunohistochemical analysis is needed to distinguish it from other thyroid and parathyroid neoplasms and metastatic carcinoma. Surgical treatment is presently the best mode of therapy.Karcinom paratiroidne žlijezde je rijedak maligni tumor. Tumor je najčešće hormonski aktivan i uzrokuje teški oblik hiperparatiroidizma s visokom serumskom razinom kalcija, poremećajima koštane gustoće i bubrežnim kamencima. Nefunkcionalni paratiroidni karcinom je iznimno rijedak. Prikazuje se slučaj 60-godišnjeg bolesnika koji je primljen na Odjel otorinolaringologije zbog velikog tumora vrata koji je komprimirao grkljan i dušnik. Prijeoperacijski su serumske vrijednosti hormona štitnjače, paratiroidnog hormona i kalcija bile unutar referentnih vrijednosti. Korišteni su slijedeći imunohistokemijski biljezi: (DAKO, Danska): bcl-2; CD-10; Chromogranin-A; Cyclin-D1; Ki-67; Mdm-2; p-53; RCC; Synaptophysin; Thyroglobulin i TTF -1. Imunohistokemijskom analizom tumora postavljena je dijagnoza primarnog karcinoma paratiroidne žlijezde. Tumorske stanice su pokazale difuzno pozitivnu imunoreakciju s kromograninom i PGP- 9,5, pozitivnu reakciju različitog intenziteta sa sinaptofizinom, te slabo pozitivnu reakciju na EM A. U citoplazmi je nađena umjereno pozitivna reakcija na bcl-2, a jezgre su bile pozitivne na p-53 i TTF -1, dok su ostali biljezi bili nereaktivni. Četiri godine nakon operacije bolesnik je umro od posljedica plućnih metastaza karcinoma bubrega i dekompenzirane jetrene ciroze. U zaključku, nefunkcionalni karcinom paratiroidne žlijezde je vrlo rijedak i težak za dijagnosticiranje. Detaljnim imunohistokemijskim metodama potrebno ga je diferencirati od ostalih tumora štitne i paratiroidne žlijezde i metastatskog karcinoma. Kirurško liječenje danas predstavlja optimalan oblik terapije

Metastaza karcinoma bubrega u nosno-sinusnoj šupljini

Renal cell carcinoma accounts for 3% of all adult malignant tumors. Common sites of metastases are lungs, bone, liver, brain and adrenal glands. Metastatic disease to the head and neck ranges from 15% to 30%. The 5-year survival rate after nephrectomy is 60%-75%, but with multiorgan metastases the 5-year survival rate is significantly lower, 0-7%. A case is presented of a female patient diagnosed with renal cell carcinoma metastases to the paranasal sinuses, diagnosed and treated at the Department of ENT and Head and Neck Surgery, Zadar General Hospital, Zadar, Croatia. The tumor was surgically removed. Unfortunately, the patient died one year after the procedure due to multiorgan failure. Although metastases of renal cell carcinoma to the head and neck are very rare, it should be first suspected when investigating a metastatic tumor in this region. Surgical excision offers the best hope for long term survival. In case of unresectable tumor, other treatment options should be considered such as radiotherapy, immunotherapy and chemotherapy.Od svih malignih tumora ljudskog organizma tumor bubrega je zastupljen u oko 3% slučajeva. Česta mjesta metastaziranja su pluća, kosti, jetra, mozak i nadbubrežna žlijezda. Pojava metastaza ovoga karcinoma u području glave i vrata kreće se oko 15%-30%. Postotak petogodišnjeg preživljenja nakon nefrektomije je 60%-75%, dok je istovjetno preživljenje s prisutnim metastazama znatno kraće, 0-7%. U ovom radu prikazuje se bolesnica kojoj je dijagnosticiran karcinom bubrega s metastazom u nosnoj šupljini i paranazalnim sinusima. Dijagnostički postupak i kirurško liječenje obavljeno je u Općoj bolnici Zadar, Odjel otorinolaringologije i kirugije glave i vrata. Tumor je uspješno kirurški odstranjen, ali je bolesnica preminula nakon godinu dana zbog višeorganskih metastaza. Metastaza bubrežnog karcinoma u području glave i vrata je vrlo rijetka. Kirurška ekscizija je metoda izbora, a u slučaju neresektabilnog tumora moguće je primijeniti radioterapiju, imunoterapiju i kemoterapiju

A view of the first BAHA system implant in Zadar General Hospital

Bone Anchored Hearing Aid ili BAHA sistem danas predstavlja novi i moderan način slušne rehabilitacije i alternativu konvencionalnim slušnim pomagalima. Od prve proizvodnje 1977. godine u Švedskoj (Entific Medical Systems, Goteborg), u širokoj je primjeni i do sada je ukupno u svijetu implantirano oko 100.000 bolesnika. U radu prikazujemo prvi slučaj implanatacije BAHA sistema na Odjelu otorinolaringologije, Opće bolnice Zadar. Ugradnja BAHA sistema učinjena je kod bolesnika s dugogodišnjom kroničnom upalom srednjega uha i kroničnim mastoiditisom, što je dovelo do teškoga oštećenja sluha. Zahvat je učinjen u lokalnoj anesteziji u jednom aktu. Po uredno završenoj osteointegraciji nakon osam tjedana postavljen je i aktiviran BAHA govorni procesor BP110. Tri mjeseca od aktivacije govornoga procesora bolesnik je iznimno zadovoljan postignutom razinom slušne rehabilitacije. BAHA sistem danas je postao opće prihvaćen i suvremen način rehabilitacije sluha. Uz adekvatan odabir kandidata i uz pravilno izveden kirurški zahvat, daje značajno bolje rezultate u rehabilitaciji sluha od konvencionalnih slušnih pomagala.Bone Anchored Hearing Aid (BAHA) today presents a new and modern way of hearing rehabilitation and an alternative to the conventional hearing aids. Since its first manufacture in 1977 in Sweden (Entific Medical Systems, Goteborg), it has been widely used and up to now around 100,000 BAHA systems have been implanted worldwide. In the present case we report on a first BAHA system implantation at the ENT Department of Zadar General Hospital. The BAHA system implantation was performed in a patient with a long term history of chronic suppurative otitis that resulted in severe hearing loss. The procedure was done under local anesthesia as a single act. Upon proper osteointegration after eight weeks, the speech processor BP110 was added and activated. Three months following the activation of the speech processor, the patient is highly satisfied with the level of the achieved hearing rehabilitation. Presently, the BAHA system was a universally accepted procedure of hearing rehabilitation, and with the proper candidate selection and meticulous surgical intervention, it gives significantly better hearing rehabilitation when compared to the conventional hearing device

The Effect of Propofol and Fentanyl as Compared with Sevoflurane on Postoperative Vomiting in Children after Adenotonsillectomy

Postoperative vomiting (PV) after adenotonsillectomy in children is a common problem with an incidence as high as 40–80%. Only few studies in the recent literature compared the effect of different anesthetic techniques concerning PV in children. The aim of this study was to compare the incidence of PV in two groups of children who underwent two different general anesthesia techniques in order to determine what type of anesthetic technique is more related to less PV. The clinical trial included 50 children (physical status ASA I, 3–12 years old) divided into 2 groups and monitored for PV 24 hours following the surgery. Group one (G1) consisted of 25 children who underwent general anesthesia with gas mixture 60% nitrous oxide and 40% oxygen and anesthetic propofol, opioid fentanyl and muscle relaxant vecuronium intravenously and group two (G2) included 25 children to whom volatile anesthesia with sevoflurane in the same gas mixture was given. Demographic characteristics (gender, age, weight, history of motion sickness and earlier PV) as well as surgical data (length of surgery and anesthesia, intraoperative blood loss) were recorded. There were no significant differences considering demographic characteristics and surgical data between the investigated groups. The incidence of PV was relatively low 3 children (12%) in G1 group and 5 children (20%) in G2 group. Statistically there was no significant difference between the groups regarding the incidence of PV and both anesthetic techniques can be used equally safe regarded to PV

Giant Basal Cell Carcinoma of the Forehead: A Case Report

Giant basal cell carcinoma (GBCC) is defined as a tumor 5cm or greater in diameter. They present less than 1% of all basal cell carcinomas. We present a case of an 85-year-old male patient with a giant ulcerating tumor of the left forehead (measuring 7x6cm). Under local anesthesia tumor was surgically excised. No involvement of the underlying periostal or bone structure was noted. Pathohystological exam revealed the giant basal cell carcinoma, with free surgical margins. Giant basal cell carcinomas are rare tumors and are usually result of a long duration and patient neglect. In comparison to the ordinary basal cell carcinoma these tumors have a higher metastatic potential. Surgical resection with negative surgical margin is the best possible treatment option