The pharyngocutaneous fistula (PCF) is the most common complication following a total laryngectomy (TL) with a wide range of incidence and various potential risk factors. The aim was to analyse the ...incidence and potential risk factors for PCF formation in a large study set collected over a longer period of time. In the retrospective study at the Department of Otorhinolaryngology and Cervicofacial Surgery of Ljubljana, 422 patients who were treated for head and neck cancer by TL between 2007 and 2020 were included. The comprehensive clinicopathologic data were collected including potential risk factors related to the patient, disease, surgical treatment and post-operative period for the development of fistulae. The patients were categorized into a group with the fistula (a study group) and one without it (a control group). The PCF then developed in 23.9% of patients. The incidence following a primary TL was 20.8% and 32.7% following salvage TL (
= 0.012). The results demonstrated that surgical wound infection, piriform sinus invasion, salvage TL, and total radiation dose were determined as independent risk factors for PCF formation. A diminishing surgical wound infection rate would contribute to a further reduction of the PCF rate.
NANOG is a stem cell transcription factor that is believed to play an important role in the development of oral squamous cell carcinoma (OSCC), but there is limited data regarding the role of long ...non-coding RNAs (lncRNAs) and microRNAs (miRNAs) in the regulation of NANOG expression. We therefore analyzed expression of NANOG, NANOG-regulating miRNAs and lncRNAs in OSCC cancerogenesis, using oral biopsy samples from 66 patients including normal mucosa, dysplasia, and OSCC. Expression analysis of
,
,
,
,
,
, and
was performed using qPCR and immunohistochemistry for NANOG protein detection. NANOG protein showed no staining in normal mucosa, very weak in low-grade dysplasia, and strong staining in high-grade dysplasia and OSCC.
,
,
, and
showed up-regulation,
and
showed down-regulation, and
showed variable expression during cancerogenesis. NANOG mRNA was up-regulated early in cancerogenesis, before strong protein expression can be detected.
was in correlation with
and
. Our results suggest that miRNAs and lncRNAs, particularly
and
, might be important post-transcription regulatory mechanisms of NANOG in OSCC cancerogenesis. Furthermore, NANOG protein detection has a diagnostic potential for oral high-grade dysplasia, distinguishing it from low-grade dysplasia and non-neoplastic reactive lesions.
Izhodišče: Eden od zapletov disekcije na vratu je hilozna fistula. Največkrat nastane zaradi poškodbe torakalnega voda. Vidi se oteklina nizko na vratu levo. Iz rane lahko izteka tekočina, ki je ...prozorna ali mlečne barve, kar je odvisno od vsebnosti maščob. Cilj zdravljenja je popolno prenehanje izcejanja tekočine. Od konzervativnih metod se najpogosteje uporablja prehrana z manj maščobami, s srednje dolgimi trigliceridi, brez maščob, kompresijsko povijanje in v zadnjem času oktreotid, ker zavira tvorbo hilozne tekočine. Zato se fistula lažje zaceli.
Klinična primera: Opisujemo dva bolnika s hilozno fistulo na vratu, pri katerih smo ob konzervativnih ukrepih uspešno uporabili oktreotid. Iz literature smo povzeli podatke o zdravljenju hiloznih fistul po disekciji na vratu z oktreotidom.
Zaključek: Zdravljenje z oktreotidom v kombinaciji z že ustaljenimi konzervativnimi postopki zapre večino hiloznih fistul na vratu brez kirurške revizije.
Sialendoskopske tehnike predstavljajo novo paradigmo, ki je bistveno spremenila zdravljenje zastojne bolezni žlez slinavk. Epidemija covida-19 predstavlja nov izziv za zdravstveni sistem sleherne ...države in postavlja na preizkušnjo številne, predvsem elektivne kirurške metode zdravljenja. Kirurški posegi v področju glave in vratu in še posebej v ustni votlini predstavljajo hudo tveganje za prenos covida-19. Pri izvajanju sialendoskopije oziroma sialendoskopsko asistirane operacije sta kirurška ter anesteziološka ekipa izpostavljeni slini in refleksom občutljivega anatomskega področja ust oziroma zgornjih dihal in prebavil. Ostaja vprašanje, kolikšno je tveganje glede na fazo operacije, vrsto anestezije, uporabljeno osebno varovalno opremo ter trenutno epidemiološko situacijo covida-19. V času pandemije covida-19 smo na Kliniki za otorinolaringologijo in cervikofacialno kirurgijo Ljubljana izvajali le nujne, kasneje pa tudi elektivne sialendoskopske in sialendoskopsko asistirane posege. Menimo, da je v času obvladljive epidemiološke situacije sialendoskopska kirurgija ob upoštevanju indikacij in zaščitnih ukrepov lahko varna za bolnika in izvajalca.
Kirugija glave in vratu med pandemijo covida-19 Zore, Sara Bitenc; Šifrer, Robert; Mavrič, Ajda ...
Zdravniški vestnik (Ljubljana, Slovenia : 1992),
02/2022, Letnik:
91, Številka:
1-2
Journal Article
Recenzirano
Odprti dostop
Kirurgija glave in vratu med pandemijo covida-19 je za zdravstveni sistem velik izziv. Pred kirurškimi posegi je potrebna ustrezna priprava in poznavanje vseh možnosti zdravljenja, da bolnik in ...zdravstveni delavci ne tvegajo okužbe. Treba je odložiti vse posege, katerih odložitev ne ogroža bolnikovega zdravja. Operacijske posege glede na nujnost delimo v tri skupine – v prvo skupino sodijo urgentni, neodložljivi posegi, v drugo skupino posegi, ki jih lahko odložimo za največ štiri tedne, in v tretjo skupino posegi, katerih odložitev za šest do osem tednov ne vpliva na izid zdravljenja. Pred predvideno operacijo je treba ugotoviti status okužbe bolnika z virusom SARS-CoV-2, razen ob urgentnih posegih, ki jih opravimo ne glede na status okužbe bolnika. Kirurški posegi glave in vratu se med seboj razlikujejo glede na možnost prenosa okužbe z virusom SARS-CoV-2 s pozitivnega bolnika na zdravstvenega delavca; pri tem upoštevamo predvsem verjetnost tvorbe aerosola med posegom. Med posege največjega tveganja sodijo endoskopske preiskave zgornjih dihal in prebavil ter žlez slinavk in operacije v tem področju, ki prekinejo sluznice. Te so: traheotomija, laringektomija, faringektomija, operacija raka ustne votline, transoralna laserska mikrokirurgija, transoralna robotska kirurgija. V skrbi za zdravje zdravstvenega osebja in bolnikov je med kirurškimi posegi nujna dosledna uporaba osebne varovalne opreme ne glede na okuženost bolnika.
Izhodišča: Juvenilni relapsni parotitis otrok in mladostnikov se kaže s ponavljajočimi in bolečimi otekanji obušesne žleze slinavke. Težave pogosto spontano prenehajo do konca pubertete, a pogosta ...vnetja poškodujejo žlezo in Stenonovo izvodilo. V zadnjem desetletju pri diagnosticiranju in zdravljenju uporabljamo sialendoskopijo. Metode: Analizirali smo podatke bolnikov z juvenilnim relapsnim parotitisom, ki smo jih obravnavali na naši kliniki med aprilom 2011 in oktobrom 2019 in pri katerih zdravljenje z zdravili ni preprečilo ponovnih zagonov bolezni. Pri-merjali smo število akutnih epizod pred sialendoskopijo in po njej, intraoperativne najdbe, prisotnost zožitev, upora-bo anestezije ter medoperativne in pooperativne zaplete. Kot merilo uspešnosti posega smo uporabili število akutnih zagonov parotitisa pred posegom in po njem. Rezultati: V raziskavo smo vključili 14 bolnikov. Opravili smo 19 sialendoskopij, 3 v lokalni in 16 v splošni anesteziji. Pred sialendoskopijo so bolniki utrpeli v povprečju 5 akutnih zagonov letno. Pri 6 bolnikih smo med posegom ugotovili prisotnost zožitev. Pri 2 bolnikih je med posegom prišlo do poškodbe izvodila. 11 bolnikov po posegu ni doživelo več nobene epizode vnetja, pri 3 bolnikih pa so se vnetja slinavke bistveno zmanjšala. Zaključek: Sialendokopija je varen in učinkovit poseg za dia-gnostiko in zdravljenje juvenilnega relapsnega parotitisa. Poseg ima malo zapletov, hospitalizacija je kratka, predvsem pa pomembno zmanjša število ponovnih vnetij.
Obstaja veliko možnosti za kritje vrzeli po onkološki kirurgiji na glavi in vratu. Najpogosteje se uporablja prosti fasciokutani radialni reženj, prosti anterolateralni stegenski reženj in vezani ...mišičnokožni reženj, t. i. pectoralis maior.Fasciokutani otočni reženj supraklavikularne arterije (SCAIF) je vsestranski reženj s področja nad ključnico in ramena. Baziran je na supraklavikularni arteriji, katere odcepišče od žile arteria transversa colli se nahaja v trikotniku na vratu, ki ga omejuje posteriorni rob sternokleidomastoidne mišice s ključnico in z žilo, poimenovano vena iugularis externa. Dolžina 26 cm, širina 6–7 cm in lok obrata omogočajo kritje kožnih vrzeli lateralno na vratu in na parotidnem področju ter v izjemnih primerih kritje temporalnih vrzeli. Na drugi strani je SCAIF uporaben za rekonstrukcijo vrzeli na sluznici ustne votline, žrela, požiralnika in za kritje fistul po operaciji.Opisujemo primer uporabe SCAIF pri bolnici z lokalno napredovalim karcinomom zunanjega sluhovoda in pri bolniku z obsežno metastazo v obušesni slinavki.Dvig SCAIF je kirurško nezahteven in hiter. SCAIF je zanesljiv, varen, ima malo zapletov in dobre funkcionalne in estetske rezultate, zato je široko uporaben za rekonstrukcijo različnih mehkotkivnih vrzeli na glavi in vratu.
Lysosomal proteases cathepsins B and L (CB, CL) and their endogenous inhibitors stefins A and B (SA, SB) are associated with tumor cell invasion and metastasis. The purpose of this study was to ...determine the immunohistochemical (IHC) localization of these parameters in tissue sections of 65 patients with operable head and neck squamous cell carcinoma (HNSCC) and to evaluate the prognostic significance of the observed IHC reactions. In SCC cells, a dot-like staining pattern for CB and CL was especially polarized in the perinuclear area and for stefins the characteristic IHC pattern was a diffuse cytoplasmic reaction. Higher SA immunoreactivity scores were found prognostically advantageous in univariate survival analysis locoregional control (LRC),
P
= 0.003; disease-free survival (DFS),
P
= 0.023; disease-specific survival (DSS),
P
= 0.030 and appeared significant for predicting LRC (
P
= 0.019) in a multivariate setting. Among node-positive extracapsular extension-negative patients, SA positivity correlated with a favorable outcome (LRC,
P
= 0.094; DFS,
P
= 0.013; DSS,
P
= 0.012). In conclusion, SA immunoreactivity in tumor cells was related to a favorable prognosis. In the neck node-positive extracapsular extension-negative subgroup, SA immunoreactivity scores can be used to identify patients at increased risk for disease relapse.
AbstractIntroduction. Sialendoscopy is a novel branch of minimally invasive surgery, which allows diagnostic and interventional procedures deep in the ductal systems of salivary glands. Clinical ...Department of Otorhinolaryngology and Cervicofacial Surgery Ljubljana is a joint otorhinolaryngological sialendoscopy center, representing in that field both Slovenian University Medical Centers.Patients and methods. Since 2011, from among more than 200 patients with unexplained swelling of the salivary glands, we have submitted 118 patients to sialendoscopy and sialendoscopy-assisted interventions and performed 131 operations (78.6% under local anesthesia), with an attempted examination of a total of 137 salivary glands. The patients had mainly submandibular problems (66%).Results. Our rate of failed sialendoscope introductions is 2.9% so far, which is comparable to the best results abroad. The most common interventional procedure was sialendoscopy-assisted combined approach salivary stone removal (36 cases). Adding 16 cases of wire basket stone retrievals, we reached a total of 52 successful stone extraction procedures. We found ductal strictures without sialolithiasis in 40 patients, mostly of parotid systems (24 patients), and in 19 of them, dilatation was performed, followed by a temporary stent insertion in 11 cases. In three patients with submandibular papillary stricture, we performed microsurgical ductostomy; our experience supports its recognition as a specific clinical entity. With no serious complications, the practice of sialendoscopy at our department reduced salivary gland resections because of obstructive disease by 90 %.Conclusions. We believe that sialendoscopy is a new minimally invasive approach paradigm that fundamentally changes the treatment of obstructive salivary gland diseases.
Purpose
To prevent the consequences of long-term endotracheal intubation, patients undergo tracheostomies. However, as COVID-19 is highly contagious, its existence has made the tracheostomy a ...high-risk procedure. Tracheostomy procedures must, therefore, be adjusted for safety reasons. The aim is to present the adjustments that should be made to the surgical technique.
Methods
Both the medical charts and surgical reports of patients with COVID-19 who were subjected to elective open tracheostomies were reviewed.
Results
The retrospective study included 25 patients. Our adjustments include the timing of tracheostomies, ideally putting them at 21 days after the onset of COVID-19, the advancement of an endotracheal tube to 26–28 cm from the upper-alveolar ridge, surgery being carried out in the intensive care unit with appropriately modified positions of the patient and providers, tracheo-cutaneous sutures, and intentionally making the small tracheal flap and the tracheal window the same shape as a medieval shield.
Conclusions
A tracheostomy performed in this way is now referred to as the Shield Tracheostomy. Further improvements to the surgical technique are expected in the future.
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