Total laryngectomy results in a permanent disconnection of the upper and lower airways. Thus, the upper airways are bypassed and can no longer condition, humidify, and filter the inhaled air, leading ...to damage of the tracheobronchial epithelium. There is little scientific information available about the effects of tracheostoma breathing and the degree of mucosal damage in laryngectomized patients. The aims of this study were to determine the histopathologic findings and investigate the potential impact of using a heat and moisture exchanger (HME) on the tracheal epithelium in long-term tracheostomy patients. Tracheal mucosal biopsies were taken from a total of 70 patients. Specimens were stained with hematoxylin and eosin and examined by a light microscope. Normal pseudostratified ciliated columnar epithelium was found in only 9 (12.9 %) cases; while, 17 (24.3 %) cases had some degree of basal cell hyperplasia. Squamous metaplasia was the most common finding (50 %). Pre-invasive lesions (mild and moderate squamous dysplasia) were found in only one patient who used an HME, and in eight (11.4 %) non-users. Although the HME cannot completely restore the physiological functions of the upper respiratory track, it delivers a better quality of air to the lower airways and has a positive effect on tracheal mucosa.
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.
The aim of this study was to analyze the voice quality of alaryngeal tracheoesophageal and esophageal speech, and to determine which of them is more similar to laryngeal voice production, and thus ...more acceptable as a rehabilitation method of laryngectomized persons. Objective voice evaluation was performed on a sample of 20 totally laryngectomized subjects of both sexes, average age 61.3 years. Subjects were divided into two groups: 10 (50%) respondents with built tracheoesophageal prosthesis and 10 (50%) who acquired esophageal speech. Testing included 6 variables: 5 parameters of acoustic analysis of voice and one parameter of aerodynamic measurements. The obtained data was statistically analyzed by analysis of variance. Analysis of the data showed a statistically significant difference between the two groups in the terms of intensity, fundamental frequency and maximum phonation time of vowel at a significance level of 5% and confidence interval of 95%. A statistically significant difference was not found between the values of jitter, shimmer, and harmonic-to-noise ratio between tracheoesophageal and esophageal voice. There is no ideal method of rehabilitation and every one of them requires an individual approach to the patient, but the results shows the advantages of rehabilitation by means of installing voice prosthesis.
The aim of this retrospective study was to provide the incidence and mortality rate for all patients with laryngeal carcinoma diagnosed in Osijek-Baranja County, during the period of 1999-2008. In ...this period, there were 329 registered patients, from which 301 (91.5%) males, and 28 (8.5%) females. Age-standardized rate (ASR World) laryngeal cancer incidence was 6.4/100,000 (13.4/100,000 for males and 0.9/100,000 for females). In the same period, 238 people, including 224 (94.1%) men and 14 (5.9%) women died of laryngeal carcinoma. Age-standardized rate (ASR World) laryngeal cancer mortality was 4.4/100,000 (9.8/100,000 for males and 0.5/100 000 for females). There is a significant decline in mortality in males and increased mortality in females. Laryngeal carcinoma is a significant public health problem in the Osijek-Baranja county. Although the study period shows a tendency to decrease in the number of new cases and deaths, in the times ahead it is important to focus the emphasis on prevention and early detection with the goal of reducing incidence and mortality.
The aim of this study was to compare the self-assessed vocal handicap of laryngectomees treated with three different communication methods: tracheoesophageal speech, esophageal speech and ...electrolarynx. Forty-eight patients, 40 males and 8 females, who had undergone total laryngectomy for laryngeal carcinoma were enrolled in the study. Depending on the voice restoration method, all patients were divided into three groups: 20 patients were tracheoesophageal speakers (group 1), 13 patients were esophageal speakers (group 2) and 15 patients were electrolaryngeal speakers (group 3). They autonomously completed the Croatian version of Voice Hendicap Index, a questionnaire that was developed to quantify the patient's perception of deficiency due to vocal dysfunction. Statistical analyses were performed using the Statistical Package for Social Sciences (SPSS 13.0), and the data obtained with each group and scale were formally compared. 31.25% of patients rated their voice disorder as a minimum handicap, 54.16% of patients rated their voice disorder as a medium handicap, and 14.58% of them rated their voice disorder as a significant handicap. There are differences between each group, but differences were not statistically significant. No single method is considered to be the best for every patient. Selection of a method should be based on the input from the patient, surgeon and speech pathologist.
The aim of this study is to show the incidence of squamous cell carcinoma of the skin in Osijek Baranja County, Eastern Croatia, in period from 2004 to 2009. This is the first report of ...epidemiological features of squamous cell skin carcinoma in this region. In this period we registered 469 patients with SCC of the skin, from which 237 females (50.5%) and 232 males (49.5%). World age-standardised rates (ASRW per 100,000) incidence in this period was 11.8/100,000 (16.8/ 100,000 for men and 9.0/100,000 for women). SCC of the skin occur in elderly commonly after 70 years. Most common localization is on the photoexposed areas, for example head, neck and backs of the hands. These localization varied in males and females (in females 2.5 times more in the nose area than males while 6 times more on the ear). The relation between photoexposed and photo non-exposed areas is 5:1. These results will serve as reference for studying the patterns of descriptive epidemiology of squamous cell carcinoma of the skin in the Osijek-Baranja County and the surrounding region.
Psychological and physical patient state as well as the influence of other social factor is of great influence voice rehabilitation. A team of experts in the field of voice and its function are ...involved in voice therapy. Our research was focused on the successfulness of voice recovery depending on the patient vocal disorder approach. We made a comparison of two methods: RVT and Accent method. We attempted to evaluate clinically relevant voice disorders in relation to certain vocal methods, we propose that a lot can be learned about voice trough therapeutic procedures, which can also be used to enhance the practical application of vocal methods and raise the level of success in dealing with people that suffer from voice pathology.
Coexistence of laryngoceles and laryngeal carcinoma is still being debated, and there are several suggested theories about the pathophysiological relationship between these two entities. We present ...the case of a 66-year-old male patient with bilateral laryngomucoceles and laryngeal squamos cell carcinoma. A systematic hystological examination of whole organ sections showed that the submucosal spreading of cancer around the saccular necks on both sides caused stenosis which probably created a one-way valve mechanism allowing air to enter the saccule but not to exit. Progression of the tumor completely obstructed the laryngeal opening, leading to glandular secretion stagnation and formation of laryngomucoceles.
Provider: - Institution: - Data provided by Europeana Collections- CILJ ISTRAŽIVANJA: proširenje dosadašnjih spoznaja o terapijskoj vrijednosti i učinkovitosti kazeta za održavanje vlažnosti i ...temperature zraka čija je uporaba jedini nefarmaceutski način liječenja i prevencije tegoba nastalih nakon totalne laringektomije. NACRT STUDIJE: prospektivna opservacijska studija ISPITANICI I METODE: U studiju je bilo uključeno 70 ispitanika - laringektomiranih osoba obaju spolova liječenih u KBC-u Osijek. Skupinu ispitanika činilo je 35 ispitanika koji se redovito koriste kazetama za održavanje vlažnosti i temperature zraka, a kontrolnu skupinu 35 ispitanika koji se njima ne koriste. Svim ispitanicima uzet je bioptat proksimalnog dijela traheje te su analizirane histološke promjene sluznice. Svi su podvrgnuti spirometriji, a na temelju dobivenih podataka procijenjen je i uspoređen morfološki i funkcionalni status donjih dišnih putova za obje ispitivane skupine. Ispitanici su potom ispunili posebno osmišljen upitnik na osnovi kojega je procijenjen utjecaj kazeta na neke aspekte kvalitete života laringektomiranih osoba. Statistička obrada podataka provedena je pomoću statističkog paketa SPSS (verzija 17.0.0, SPSS Inc., Chicago, IL, SAD). REZULTATI: Blago zadebljanje bazalnih stanica epitela nađeno je u 8 (11 %), srednje zadebljanje bazalnih stanica epitela u 7 (10 %), a jako zadebljanje bazalnih stanica epitela u 2 (3 %) ispitanika. Najveći broj ispitanika imao je nalaz pločaste metaplazije 35 (50 %). Blaga displazija nađena je u 5 (7 %), a umjerena u 4 (6 %) od 70 ispitanika. Postoji statistički značajna razlika u pojavnosti najtežih, prekanceroznih promjena (displazije) u bioptatu sluznice traheje u promatranim skupinama. Displazija I. i II. stupnja nalazi se u 1 (1 %) ispitanika u skupini koja se koristi kazetama, a u 8 (11 %) ispitanika kontrolne skupine. Ispitivani spirometrijski parametri za sve kategorije pokazuju bolji rezultat nalaza u kategoriji ispitanika koji nose kazetu u usporedbi s onima oni ju koji ne nose, no ni za jedan parametar nije nađena statistički značajna razlika u ispitivanim skupinama. Svi su ispitanici ocijenili ukupno 10 obilježja vezanih uz dišne putove, osjetilne funkcije i gornji dio probavnog sustava (bol u vratu, problemi vezane uz usnu šupljinu, osjet okusa i mirisa, tegobe s disanjem i nosnom sekrecijom, problemi s gutanjem, govor, kašalj i iskašljavanje). Od ukupno 10 ocijenjenih kategorija, postoji statistički značajna razliku u pojavnosti osjećaja boli u području vrata te osjeta okusa. Od ukupno osam obilježja vezanih uz psihosocijalno funkcioniranje u vlastitom okruženju, statistički značajna razlika nađena je u ocjeni kvalitete komunikacije, socijalne interakcije i koncentracije. ZAKLJUČAK: Kazete za održavanje vlažnosti i temperature zraka mogle bi imati ulogu u očuvanju staničnog integriteta respiratornog epitela. Rezultate spirometrije koji ne pokazuju statistički značajnu razliku za dvije ispitivane skupine moglo bi se pripisati malom uzorku, no ipak predstavljaju značajan temelj za buduća istraživanja. Kazete za održavanje vlažnosti i temperature zraka povoljno utječu na neke simptome koji su uobičajeni nakon totalne laringektomije te na neke aspekte kvalitete života laringektomiranih osoba.- OBJECTIVES. Expansion of previous cognitions on therapeutic values and effectiveness of the heat and moisture exchanger as its use is the only non-pharmaceutical way of treatment and prevention of pulmonary complications after total laryngectomy. STUDY DESIGN. Prospective observational study. PATIENTS AND METHODS. The study included 70 respondents – laryngectomized persons of both genders who were treated at Clinical Hospital Center Osijek. There were 35 respondents who regularly used heat and moisture exchangers and 35 respondents in control group who didn't use them. Biopsy specimen of the proximal part of the trachea has been taken in all respondents, and histological changes of the tracheal epithelium have been analysed. All of them have undergone spirometry. According to the obtained data morphological and functional status of lower respiratory tract has been evaluated and compared in both groups of respondents. Subsequently, the respondents have filled in a questionnaire according to which the influence of the heat and moisture exchanger onto some aspects in life quality of patients after laryngectomy could be evaluated. Statistical analysis was performed with SPSS Statistics (Version 17.0.0, SPSS Inc.,Chicago, IL, USA). RESULTS. Mild basal cell hyperplasia has been found in 8 (11 %), moderate basal cell hyperplasia in 7 (10 %), and advanced basal cell hyperplasia in 2 (3 %) respondents. Squamous metaplasia was the most common finding (50 %). Mild dysplasia was found in 5 (7 %), and moderate dysplasia in 4 (6 %) of 70 respondents. There is a statistically significant difference in manifestation of most severe, precancerous changes (dysplasia) in tracheal biopsy specimen in both groups. Mild and moderate squamous dysplasia has been found in 1 (1 %) user, and in 8 (11 %) non-users. Although the examined spirometric parameters for all categories show a better result in experimental group, statistical comparison has not detected any significant differences between the experimental and control group. All respondents graded 10 characteristics connected to respiratory system, sensory functions and the upper part of digestive system (neck pain, dry mouth, taste and smell, breathing problems, nose secretion, swallowing problems, speech, cough and expectoration). Out of 10 categories evaluated three were statistically significant difference in neck pain and taste. Out of eight characteristics connected to psychosocial functioning in the environment, statistically significant difference was found in communication, social interaction and concentration. CONCLUSION. Heat and moisture exchanger could have an important role in protection of respiratory epithel cell integrity. Spirometry results which didn't show statistically significant difference for the two examined groups could be explained by small sample, but they represent an important basis for future research. Heat and moisture exchanger positively influences some symptoms that are frequent after total laryngectomy, as well as some aspects of the life quality in patients after total laryngectomy.- All metadata published by Europeana are available free of restriction under the Creative Commons CC0 1.0 Universal Public Domain Dedication. However, Europeana requests that you actively acknowledge and give attribution to all metadata sources including Europeana
During the past several decades there has been a substantial increase in the incidence of malignant melanoma worldwide. The highest incidences were reported in New Zealand and Australia. In Europe ...the northern countries generally have a higher incidence. The aim of this retrospective study was to provide the incidence and mortality for all patients with malignant melanoma diagnosed in Osijek-Baranya County, Eastern Croatia, during 2000-2008. In the past 30 years in the Republic of Croatia the incidence of melanoma increased by 337%. During the period of 2000-2006 in Osijek-Baranja County, the incidence of melanoma increased by 13%. The incidence of melanoma increases with age, but in past decades melanoma is more often diagnosed in people aged 25-40. The mortality between 2000 and 2008 increased by 18%. The incidence of melanoma generally increases equally in men and women. The most common localization of skin melanoma in males was trunk and in females the lower extremities. Presently, in Osijek-Baranya County melanoma is 15th on the list of malignant tumors and represent 2% of all malignant tumors. In New Zealand, Australia and European northern countries mortality is reduced, as result of earlier diagnosis and education of risk groups. Unfortunately, in Osijek-Baranya County, in a comparison with these countries, the mortality is higher although incidence is the same or lower.
