The Association between the Level of Advanced Glycation End Products and Objective Skin Quality Parameters.

Advanced glycation end products (AGEs) represent an endogenously produced or exogenously derived group of compounds derived from nonenzymatic glycation. Recent experimental studies are suggesting that AGEs could play an important role in the skin's quality and its aging process. Hence, the aim of this study was to clinically evaluate the AGEs and skin quality parameters across different age groups in the general population. The study included 237 participants. Melanin, erythema, hydration, friction and transepidermal water loss (TEWL) were evaluated using noninvasive probes, while AGEs were evaluated using a skin autofluorescence reader. There was a significant positive correlation between AGEs and the amount of melanin (p < 0.001), erythema (p < 0.001) and TEWL (p < 0.001), while there was a significant negative correlation between AGEs and hydration (p < 0.001) and friction (p < 0.001). After dividing the sample into three groups depending on their age, in all three groups, there was a significant positive correlation between AGEs and the melanin count (p < 0.001) and TEWL (p < 0.001), while there was a significant negative correlation between AGEs and skin hydration (p < 0.001). Multiple linear regression analysis showed that the level of AGEs as a dependent variable retained a significant association with age (p < 0.001), melanin (p < 0.001), erythema (p = 0.005) and TEWL (p < 0.001) as positive predictors. Moreover, AGEs retained a significant association with skin hydration (p < 0.001) and friction (p = 0.017) as negative predictors. These outcomes imply that AGEs could be linked with the complex physiology of the skin and its aging process.

Feather foreign body caused periparotid and peritonsillar abscess in a 9-month-old girl.

Migratory foreign body appeared to be bird feather, caused peritonsillar and periparotid abscess in a nine-month-old infant. Patient presented painful, tender and fluctuating red neck mass on the left neck region II, and refusal of oral intake, with no fever. Azithromycin was introduced four days before presentation for suspected urinary tract infection. ENT examination revealed left peritonsillar abscess; ultrasound confirmed periparotid abscess, MSCT verified both diagnoses. Under general anaesthesia, we performed abscess incision, after pus drainage, small foreign body spontaneously came through the wound. After washing it with saline, it appeared like a bird feather. Subsequently, peritonsillar abscess was incised and drained. After 24-hour postoperative care on pediatric intensive care unit, the patient continued three-day parenteral antibiotic treatment on the otolaryngology department; it was discharged with a recommendation to continue seven days of oral antibiotic therapy. Suggested mechanism was ingestion of bird feather from stuffed bedding, that got trapped in the tonsillar crypt. Afterwards, it started to migrate through the neck tissue. Households with children younger than three years should not have feather stuffed clothes or beddings.

Surgical Treatment of Recurrent Metastatic Parathyroid Gland Carcinoma.

AIM: We present the case of a 48-year-old male patient who underwent surgery for a recurrent metastatic parathyroid gland carcinoma in the patient's right paratracheal space of the neck. The patient had undergone surgery for lower right parathyroid gland carcinoma 28 months earlier. RESULTS: The metastases were resected en bloc with an ipsilateral central neck dissection and with the removal of the enlarged lower left parathyroid gland. After exploration of the remnant parathyroid glands we noticed that lower left parathyroid gland was macroscopically enlarged so we decided to remove it to prevent possible hypercalcemia in future and to also prevent possible recurrence of cancer or development of a new primary, considering the identical embryological origin of the lower parathyroid glands and possibility of synchronous, multiple tumors, which generally follow the same embryological origin if they occur. The patient was also treated with radiation therapy after the surgery. CONCLUSION: With the present surgical approach to recurrent metastatic parathyroid gland carcinoma, we aimed to prevent the recurrence of cancer or development of new primary and prevent or delay hypercalcemia in the future with all severe adverse metabolic states associated with high serum calcium levels.

Effect of Methimazole Therapy on Thyroid Pathohistology That May Mimic Thyroid Malignancy.

Diffuse toxic goiter, as the most common cause of hyperthyroidism, is usually initially treated with thyrostatic drugs such as methimazole, followed by radioiodine therapy or surgery which may be indicated as definitive treatment. Radioactive iodine therapy has a known association with various histopathologic features including cytologic atypia, but herein we present a rare example of morphological thyrocyte changes induced by long-term pharmacological treatment with methimazole that mimicked thyroid malignancy in a pathohistological sample.

Treatment Approach to Follicular Thyroid Carcinoma Tumor Thrombus in the Internal Jugular Vein and Brachiocephalic Vein.

Thyroid gland carcinoma causing tumor thrombus in the great veins of the neck and mediastinum is a rare condition with poor prognosis. Invasion of the internal jugular vein by thyroid gland carcinoma has been occasionally reported, but tumor thrombi extending to the great veins of the mediastinum are reported extremely rarely. We present a treatment approach in a case of follicular thyroid carcinoma intravascular tumor thrombus in the left internal jugular and left brachiocephalic vein.

Association between EGFR expression and clinical outcome of laryngeal HPV squamous cell carcinoma.

Background: Expression of the epidermal growth factor receptor (EGFR) and human papillomavirus (HPV) DNA can serve as independent prognostic factors in squamous cell carcinoma (SCC) of the larynx. EGFR correlation with the course of disease and its effect on survival makes EGFR expression a negative prognostic factor, whereas HPV DNA is a positive prognostic factor. Aim: To assess the association of EGFR expression with clinical outcome of laryngeal HPV SCC. Materials and methods: This retrospective study included 196 SCC patients operated on at the Department of ENT, Head and Neck Surgery, Split University Hospital Center in Split, Croatia, between 1 January 2000 and 31 December 2009. Results: The association of HPV infection and EGFR expression was found to be statistically significant, and so was the difference in survival between patient groups with different HPV to EGFR expression ratio. Conclusions: The group of laryngeal HPV SCC patients with increased EGFR expression had shorter survival, confirming EGFR as a major component in predicting patient prognosis and survival. Significance: This article confirms the importance of EGFR expression as a biomarker in laryngeal SCC.

RET EXPRESSION AND ITS CORRELATION WITH CLINICOPATHOLOGIC DATA IN PAPILLARY THYROID CARCINOMA.

- The purpose of this study was to analyze the possible prognostic value of RET mutation in papillary thyroid carcinoma and its incidence in the past few decades in our population, due to the increasing incidence of papillary thyroid carcinoma. The present study included 180 patients operated for papillary thyroid carcinoma. The clinical and histopathologic characteristics were analyzed. Paraffin sections of the selected histologic slides were cut again and immunohistochemically stained by the Clone 3F8 P (HIER) from Novocastra (Vision Bio Systems Europe, Newcastle upon Tyne, UK) monoclonal antibody to RET oncoprotein. Univariate analysis indicated sex (p=0.01), histologic subtype (p=0.075) and capsular invasion (p=0.010) to be statistically significant predictors of lymph node metastases, whereas age (p=0.796), tumor size (p=0.556) and intraglandular dissemination (p=0.131) showed no such correlation. The presence of RET mutation (p=0.704) was not a statistically significant predictor of the tumor metastasizing potential. RET mutation (p=0.500) showed no statistically significant correlation with papillary thyroid carcinoma classifed into prognostic groups according to clinicopathologic features either. RET mutation was detected in 30% of 180 papillary thyroid carcinomas. This is the first large study demonstrating that RET mutation incidence in papillary thyroid carcinoma in Croatian population is consistent with the classic distribution of sporadic cases, despite the increased prevalence of papillary thyroid carcinoma in the past few decades.

Cyclin D1, Ret and P27 Expression in Papillary Thyroid Microcarcinoma

Th e aim of the study was to determine the influence of RET, p27 and cyclin D1 on regional lymph node metastases in papillary microcarcinoma. The analysis included 70 patients with papillary thyroid microcarcinoma that underwent surgery at Split University Hospital Center between 1999 and 2001. Immunohistochemistry was performed on formalin-fixed, paraffin-embedded tissue by the RET, p27 and cyclin D1 antibodies. Quantification was based on the intensity and distribution of nuclear staining, dividing tumors into those that showed expression (expressors) and those that showed no expression (non-expressors). Univariate analysis using χ²-test and Fisher exact test was performed with the level of statistical significance set at p<0.05. There was no statistically significant difference in the incidence of metastases according to the expression or non-expression of RET mutation (χ²-test: p=0.459; Fisher exact test: p=0.672). Among 25 cases with cyclin D1 expression, 6 had metastases, whereas only 2 of 45 cases with no cyclin D expression had metastases (χ²-test: p=0.014; Fisher exact test: p=0.021), indicating that the expression of cyclin D1 is not crucial for the development of metastases in lymph nodes. In contrast, analysis of p27 expression showed it to be significantly associated with lymph node metastasis because 3 of 45 patients with p27 expression had metastases, indicating a statistically significant correlation between p27 expression and lymph node metastases (χ²-test: p=0.093; Fisher exact test: p=0.124). This study confirmed the importance of the evaluation of RET, p27 and cyclin D1 expression and demonstrated the validity of their application in the assessment of microcarcinoma behavior.

Historical Contribution of Otorhinolaryngology in Split Region till 1923.

The beginnings of the modern otorhinolaryngology in Croatia started in the second half of the 19th century. Before that, there were only rare attempts of some doctors who published medical papers touching the frame of otorhinolaryngology. Mainly those were the PhD's disertations at Vienna, Budapest and Padua University. Among them there was dr Ivo Manola from Split, who in Padua in 1834 took a doctor's degree dealing with otologic diseases. Dr Nikola Fertilio (Nerezisca the island of Brac, 1861--Trieste, 1928) was the first otorhinolaryngologist out of a hospital in Split and Dalmatia. He studied medicine partly in Graz and Vienna, where he graduated in 1890. During 1903 he finished severeal otorhinolaryngological courses which were held by professors Viktor Urbantschitsch and Alfred Bing and by private doctor assistant professor Markus Hajek. During the winter 1903/04 he attended the "Semestralkurs über praktische Orhenheilkunde" at professor Adam Politzer, founder and managing director of the first Otology Clinic in Vienna and the world in 1873. He worked in Trieste, where he practiced otorhinolaryngology. Dr. Fertilio a specialist for diseases of nose, ear and throat, occasionally, usually during his holidays, came from Trieste to Dalmatia (Split, Zadar, Sibenik, Dubrovnik and Kotor) to treat and operate patients. He was comming to Split from 1904 till 1914. He published and announced his commings in the local newpapers. He used to come in summer, most often in August and stayed from several days till two weeks. He stayed and had a practice in Hotel Bellevue. As there wasn't an otorhinolaryngologist in the regional hospital of Split till 1923, otorhinolaryngological operations were occasionally performed by doctors of other surgical branches. Otorhinolaryngologist dr Aleksandar Dorsner came to Split hospital in 1923 and organized otorhinolaryngological service that he led till 1934.

Epidermal growth factor receptor (EGFR) expression in patients with laryngeal squamous cell carcinoma.

To assess the epidermal growth factor receptor (EGFR) correlation with histopathologic and clinical characteristics of laryngeal squamous cell carcinoma (SCC) and the impact of EGFR overexpression on patient survival. This retrospective study included 185 SCC patients treated at Clinical Department of ENT, Head and Neck Surgery, Split University Hospital Center between January 1, 2000 and December 31, 2009. A statistically significant correlation (p < 0.001) was recorded between the level of EGFR expression and SCC histopathologic grade, stage, metastasizing potential, relapsing potential, and patient survival. Kaplan-Meier survival curve yielded a statistically significant difference (χ(2) = 75.05; p < 0.001) among the four patient groups with different levels of EGFR expression. The higher the level of EGFR expression, the poorer is the patient prognosis and survival. In our study, expression of EGFR as a biomarker showed a potential predictive value in laryngeal SCC.

Expression of matrix metalloproteinase-9 in patients with squamous cell carcinoma of the larynx.

Aim of this study was to investigate the correlation of matrix metalloproteinase-9 (MMP-9) expression with histopathologic and clinical characteristics of laryngeal squamous cell carcinoma, and to assess the role of MMP-9 expression in patient survival. Study included 196 patients with squamous cell carcinoma of the larynx treated at ENT Department, Split University Hospital Centre, from January 1, 2000 till December 31, 2009. The level of MMP-9 expression showed a statistically significant correlation (p < 0.001) with the disease histopathologic grade, stage, metastatic potential, recurrence potential, and survival. Kaplan-Meier curve yielded a statistically significant survival difference (p < 0.001) among the three patient groups with different levels of MMP-9 expression. The survival curve clearly showed the MMP-9 expression as a predictor of survival to be significantly (p < 0.001) associated with survival. In this study, MMP-9 expression as a biological marker showed a potential predictive value in laryngeal squamous cell carcinoma.

Polypoid angiomyofibroblastoma tumor of nasal cavity: case report.

We report an extremely rare case and localization of polypoid angiomiofibroblastoma tumour, a case report and review of the world literature concerning angiomiofibroblastoma tumour. We present the case of a 74-year-old man who underwent left anterior and posterior ethmoidectomy with extirpation of tumour mass from left nasal cavity, epipharinx and left sphenoid sinus. The prognosis for this group of tumour is good and patient didn't receive any kind of therapy except surgical treatment. To our knowledge, this is a rare report in the world literature of polypoid angiomiofibroblastoma tumour of nasal cavity. This case indicates that angiomiofibroblastoma tumour of nasal cavity and paranasal sinuses is a rare disease including its localisation which otolaryngologists should be aware of and one which should be included in the differential diagnosis of tumours involving sinonasal tract.

Does life along the sea carry greater risk of thyroid cancer?

Aim of this study was to determine whether there are any differences between coastal and inland Dalmatia in incidence rates and clinical characteristics of thyroid cancer. Data on 651 persons who suffer from and have undergone surgery for thyroid cancer have been analysed. All patients lived in Dalmatia between 1997 and 2006. Data were collected via surveys, insight into medical histories and results of histopathological analysis. In Dalmatia, in the overall sample, there are no statistically significant differences in incidence between coastal and inland areas (chi2=3.03; df=1; p=0.082). Somewhat higher overall incidence has been recorded in the inland (8.5%000) than in the coastal Dalmatia (7.3%000). In the overall sample, in Dalmatia, women make up 81.4% of patients and papillary cancer accounts for 80.0% of all thyroid cancers. The ratio of papillary to folicullar cancer is 7.8:1 in coastal and 4.2:1 in inland Dalmatia. Papillary and medullary types are more common in the coastal area and follicular and anaplastic cancer types in the inland area and the differences are statistically significant (p>0.033). Epidemiological characteristics of thyroid cancer in coastal Dalmatia are in accordance with the characteristics of this cancer as described in iodine-sufficient areas: the most common type is papillary cancer, and the ratio of papillary to follicular is 7.8:1. Sex-wise, the coastal area records a higher ratio of male patients (1:3.8) than the inland area (1:7.1). There are no statistically significant differences in thyroid cancer incidence rates between coastal and inland Dalmatia. Epidemiological characteristics of thyroid cancer in inland Dalmatia are in some ways more similar to those of continental Croatia. This result could be the consequence of previous iodine insufficiency in inland Dalmatia.

Iodine intake and epidemiological characteristics of thyroid cancer: comparison between inland and littoral Croatia.

The aim of the study was to determine epidemiological characteristics of thyroid cancer in Dalmatia and Slavonia, to analyze regional differences in its incidence, and to determine whether iodine intake had an impact on the incidence. This epidemiological study was based on data published by the Croatian National Cancer Registry (CNCR) in the Croatian Health Service Yearbook and CNCR Bulletin. Data on 651 thyroid cancer patients operated on in Dalmatian hospitals between 1997 and 2006 were analyzed. Control group consisted of thyroid cancer patients operated on in Slavonia (N = 498). Incidence rates recorded in Dalmatia were compared with those in Slavonia. Iodine intake was measured in elementary schoolchildren in the Split-Dalmatia and Osijek-Baranya Counties. Iodine excretion levels were measured in 131 children. In the 10-year period, the mean age-standardized incidence rate (ASR) of thyroid cancer was 9.32 per 100,000 inhabitants in Dalmatia and 6.02 in Slavonia. The difference was statistically significant (P < 0.001). Incidence rates (World ASR, European ASR, crude incidence rate and research rates) showed an increase and were significantly higher in Dalmatia than in Slavonia. Patient sex structure showed the disease to be 4 times more common in women than in men. In Dalmatia sample, women accounted for 81.4% of all patients and papillary cancer accounted for 80.03% of all thyroid cancers. Median age of new patients was 50 in Dalmatia and 48 in Slavonia. Papillary cancer accounted for 63.7% of all patients in Slavonia. Follicular thyroid cancer accounted for 20.9% of patients in Slavonia and 12.4% in Dalmatia. Epidemiological characteristics of thyroid cancer in Dalmatia were found to be consistent with the characteristics of this cancer in iodine-sufficient areas: papillary carcinoma was the most common type and the papillary to follicular ratio was 6.4:1. Follicular cancer accounted for 12.4% of the total number of patients. In Slavonia, the papillary form predominated, the papillary to follicular ratio was 3:1, and follicular cancer accounted for 20.88% of all patients. Median urinary iodine excretion in elementary schoolchildren was 23.6 microg/dL in the Split-Dalmatia County and 28.1 microg/dL in the Osijek-Baranya County. The difference was not statistically significant (P < 0.050). In conclusion, the average iodine intake levels in Dalmatia and Slavonia were not the cause of the high thyroid cancer incidence in the 1997-2006 period. Improved thyroid cancer diagnosis may be one of the causes of the increased thyroid cancer incidence in Dalmatia.

[Epidemiological characteristics of thyroid cancer in Dalmatia, Croatia]. / Karcinom stitnjace u Dalmaciji: neke epidemioloske osobitosti.

OBJECTIVES: To determine epidemiological characteristics of thyroid carcinoma in Dalmatia, and to compare the incidence rate in Dalmatia with that in Croatia. STUDY DESIGN: Retrospective epidemiological study. SUBJECTS AND METHODS: Epidemiological indicators of thyroid carcinoma were compared between Dalmatia and Croatia as a whole, while some epidemiological indicators were compared with the characteristics of persons suffering from thyroid carcinoma in Croatia. The study included 651 persons suffering from and/or operated for thyroid carcinoma in Dalmatia between 1997 and 2006. Data were obtained from case histories, including the results of histopathologic analysis. The area of Dalmatia includes Zadar, Sibenik-Knin, Split-Dalmatia and Dubrovnik-Neretva counties (overall 861,060 inhabitants, surface 11,960 square kilometers). RESULTS: The incidence of thyroid carcinoma in Dalmatia ranged from 5.2 (1997) to 10.2 per 100,000 inhabitants (2006). The mean age adjusted incidence rate of thyroid cancer in the last 10 years was 8.1 in Croatia and 9.32 per 100,000 inhabitants in Dalmatia. All incidence rates observed (Europe and world-age standardized rates, crude incidence, incidence based on research) showed a rising trend and were significantly higher in Dalmatia than in Croatia. According to sex structure, in both study areas thyroid cancer affected predominantly women, who had four times more chances of falling ill. In Dalmatia, in the overall sample, women accounted for 81.4% of all patients. In Dalmatia, papillary thyroid carcinoma was diagnosed in 80.0% of the overall sample. The median age of newly diagnosed thyroid cancer patients was 50 in Dalmatia. There was no statistically significant sex difference in the prevalence of histologic types of thyroid carcinoma in Dalmatia (P=0.318). In both sexes, papillary carcinoma was the most common type, followed by follicular, medullary and anaplastic thyroid carcinomas. CONCLUSION: The incidence rate of thyroid cancer showed a rising trend and was significantly higher in Dalmatia than in Croatia. Epidemiological characteristics of thyroid gland carcinoma in Dalmatia were consistent with the reported characteristics of this carcinoma in iodine-sufficient areas: papillary carcinoma was prevalent and the papillary to follicular carcinoma ratio was 6.4:1.