Cilj ovog istraživanja bio je prikazati utjecaj pandemije COVID-19 na rad Klinike za bolesti uha, nosa i grla i kirurgiju glave i vrata KBC-a Zagreb.
Iz računalne baze podataka KBC-a Zagreb te baze ...onkoloških bolesnika Klinike retrospektivno su izvučeni te uspoređeni podatci o izvršenim postupcima i dijagnozama u razdoblju prva četiri mjeseca 2019., 2020. te 2021. godine.
Ukupan je broj slučajeva 2020. bio veći za 32,4%, a 2021. za 13,19% (p<0,001), u usporedbi s 2019. godinom. Odjel za kirurgiju glave i vrata zabilježio je pad od 31,9%, Odjel za dječju otorinolaringologiju 41,89%, Odjel za otologiju 66,67% te Odjel za rinosinusologiju 82,47%. Odjel za maksilofacijalnu kirurgiju te Zavod za tumore glave i vrata zabilježili su porast slučajeva, 71,08% odnosno 31,1%. Pregledom dijagnoza zabilježen je manji broj poremećaja štitnjače (–57,14%), devijacija nazalnog septuma (–85,14%), bolesti srednjeg uha i mastoida (–75,35%), tonzila i adenoida (–52,64%). Porastao je broj tumora glave i vrata (165,4%), prijeloma kostiju lica (95%) te rascjepa usne i nepca, kojih je u 2021. bilo 19, a nijedan u prethodne dvije godine. Novodijagnosticiranih karcinoma grkljana bilo je 2021. za 35% više nego 2019. godine. Broj karcinoma grkljana T1 bio je 2021. manji za 22,2%, dok je broj T2 bio veći za 133%.
Ovim radom prikazali smo smanjenje ukupnog broja postupaka u prvoj trećini 2020. i 2021. godine u odnosu na 2019., ali i značajan porast kompleksnosti operacija i broja postupaka bolesnika s tumorima glave i vrata. Iz naših rezultata pokazano je kako je zbrinjavanje znatno većeg broja bolesnika kirurgije glave i vrata moguće i u izvanrednim uvjetima u ustanovi koja je kadrovski i tehnološki kvalitetno opremljena. To ukazuje na važnost razvijanja centara izvrsnosti koji i u slučaju povećanog pritiska na zdravstveni sustav mogu osigurati najviše standarde liječenja kompleksnih bolesnika.
The aim of this study was to determine the long term histopathologic changes in tracheal mucosa after a total laryngectomy , and to find out the relationship between the progression of ...histopathologic changes in tracheal mucosa and the duration of breathing through the tracheostomy. Tracheal mucosal biopsies were taken from a total of 35 patients, of both sexes, who underwent a total laryngectomy for laryngeal carcinoma at least one year prior. Histologic specimens of tracheal mucosa were stained with hematoxylin and eosin and examined under light microscopy. Almost all of the patients demonstrated histopathologic changes or abnormalities. Based on the results, histological findings were grouped into seven categories: normal respiratory epithelium, mild, moderate and advanced basal cell hyperplasia, squamous metaplasia, and slight and moderate and dysplasia. The time elapsed since surgery was calculated for each histopathological change separately. In laryngeal carcinoma patients, after a total laryngectomy histopathologic changes occur in tracheal mucosa. The mildest histopathological changes are found in the patients who had a longer period between the operation and the examination.
To investigate the prognostic value of urokinase-type plasminogen activator (uPA) and its inhibitor, type-1 plasminogen activator inhibitor (PAI-1), in differentiated thyroid cancer.
Prospective ...cohort study.
University hospital.
Cytosolic concentrations of uPA and PAI-1 were determined in 105 patients with differentiated thyroid carcinoma and normal matched tissues using an enzyme-linked immunoassay (ELISA).
Both uPA and PAI-1 concentrations were significantly higher in differentiated thyroid tumors (uPA = 0.509 ± 0.767 and PAI-1 = 6.337 ± 6.415 ng/mg) compared to normal tissues (uPA = 0.237 ± 0.051, P < .001; PAI-1 = 2.368 ± 0.418 ng/mg, P < .001). uPA and PAI-1 were significantly higher if extrathyroidal invasion (uPA, P = .015; PAI-1, P < .001) or distant metastasis (PAI-1 P < .001) was present, as well as in tumors whose size exceeded 1 cm in diameter (uPA, P = .002; PAI-1, P = .001). Survival analysis revealed the significant impact of both uPA and PAI-1 on progression-free survival (PFS) (82.22 vs 49.478 months for patients with low and high uPA, respectively, P < .001; 87.068 vs 44.964 months for patients with low and high PAI-1, respectively, P < .001). Univariate analysis showed that gender, tumor size, tumor grade, extrathyroid invasion, local lymph node involvement, distant metastasis, uPA, and PAI-1 were significant predictors of PFS. However, multivariate analysis identified only distant metastasis and tumor tissue uPA and PAI-1 as independent prognostic factors.
These findings indicate that high uPA and PAI-1 levels represent independent unfavorable prognostic factors in patients with differentiated thyroid carcinoma.
The goal of this retrospective study is the evaluation of pectoralis major myocutaneous pedicle flap (PMMPF) reliability in clinical practice based on the analysis of the leading indication and ...postoperative complications. In the period from 2005 to 2011 at the University Department of Otorhinolaryngology and Head and Neck Surgery, Zagreb University Hospital Center, a total number of 27 PMMPF were used in the treatment of 26 patients. Indications for flap use were upper aerodigestive tract and soft tissue defects following resection of head and neck cancer. One-stage reconstructive technique was used in all patients. Basic demographic data, clinical stage of malignant disease, indications, postoperative complications and management of flap-related complications were systematically analyzed. In 24 cases (89%) leading indication for flap use was primary defect reconstruction following head and neck carcinoma resection and in 3 cases (11%) "salvage" reconstruction following salivary fistula formation and flap-related complications. Tumor invaded skin in 2 (8%) cases, oral cavity in 1 (4%) case, oropharynx in 12 (46%) cases, larynx and/or hypopharynx in 10 (38%) cases and major salivary gland in 1 case (4%). Mucous defect occurred in 21 (81%), cutaneous defect in 3 (11%) and muco-cutaneous defect in 2 patients (8%), respectively. 16 postoperative complications (59.3%) were recorded but only one patient (4%) sustained total flap necrosis. Previously irradiated patients had significantly higher postoperative complication rate. The rate of complications requiring surgical treatment was 25%. Although the overall complication rate was substantially high, PMMPF achieved desired reconstructive goal in 96% cases. Functional and aesthetic assessment was difficult due to the small series of patients. In conclusion, pectoralis major myocutaneous pedicle flap is still safe and acceptable reconstructive method in surgical treatment of patients with head and neck tumors.
Endoscopic CO2 laser surgery (ELS) is a widely accepted treatment modality for early laryngeal cancer. Commonly reported advantages of ELS are good oncologic results with low incidence of ...complications. Although less common if compared with open procedures, complications following ELS can be very serious, even with lethal outcome. They can range from intraoperative endotracheal tube fire accidents to early and late postoperative sequels that require intensive medical treatment, blood transfusion, or revision surgery. We present our institutional experience, discuss the possible complications of ELS for laryngeal cancer, and outline the concepts of their treatment, with comprehensive literature review. Complications are more frequent following the treatment of supraglottic as compared to glottic cancer. If compared with open surgery, ELS for laryngeal cancer is associated with a lower incidence of complications. Every surgeon performing ELS should comply with particular strategies to avoid complications in the first place, and have a clear concept of their management if they occur.
In head and neck squamous cell carcinoma distant metastases are rare and metastases to the heart are extremely rare. In this report we present a patient with a sublingual and laryngeal carcinoma with ...metastases to lung and heart. Cardiac metastases present with non-specific symptoms that depends on the size and location of the metastases. The ideal tools for diagnosing cardiac metastases are echocardiography and cardiac MRI. CT scan could be used as a screening method of distant metastases in head and neck cancer. The treatment of cardiac metastases is generally ineffective.
Health care quality in military forces in peacetime is a major national interest. Military health care organization together with civil health care should be the carrier of health protection through ...the integrated health service system during war and other emergency situations. Answer to the question of the need of military medicine maintaining and further development in Croatia should be searched through a few elements. These are health service experiences from the war in Croatia and their expert scientific evaluation. The development of the Croatian state and Croatian Army as member of international military integrations is an undisputable element which speaks for further development of military medicine. The pending danger from not only natural disasters but terrorism as well calls for an appropriate answer by all countries, including Croatia, considering the position of military medicine. The importance of further military medicine strengthening through an integrated health system, the role of which especially increases in emergency situations, is indicated in all these reasons. The integration is needed to achieve a more economical use of all health service potentials, which means unique planning and coordinated action based on the unique principles. Integrated health care system does not mean organizational joining of civilian and military health care service into one service but each of these has a distinct working area, responsibilities and command.
PDF
