Indirect laryngeal surgery of vocal fold polyps: a dying or evolving art?

Objective: Vocal fold polyps (VFPs) are the most common benign laryngeal lesions that require surgery and are routinely managed by microlaryngoscopy (MLS) under general anaesthesia. Prior to introduction of MLS, VFPs were removed using indirect laryngoscopic surgery (ILS) in local anaesthesia, a procedure that required substantial surgical skill to operate with an unmagnified mirror view of the larynx. With the adoption of wireless endoscopy equipment and personal computers, we tried to simplify this technique so that it can be easily performed in the office. This study aimed to assess the effectiveness of ILS by comparing voice outcomes with MLS. Materials and methods: ILS and MLS were performed in six patients each. Treatment outcomes were measured using a voice self-assessment and objective acoustic analysis. The total cost of both procedures was calculated. Results: Both techniques allowed successful removal of VFPs in all patients, without significant intergroup differences in voice outcomes. The cost of ILS was significantly lower. Conclusions: Despite the pilot nature of the study and the small sample size, our data indicate the potential value of this technique which, considering its simplicity and economic value could be used as an alternative to MLS in carefully selected patients.

Recording blood pressure and eGFR in primary care after the Belgrade screening study.

BACKGROUND: In 2009, Belgrade nephrologists and general practitioners from thirteen health centers carried out screening for chronic kidney disease (CKD). Three years later, medical records of patients from four health centers participating in the screening study were retrospectively analyzed in order to check whether general practitioners had continued to control patients at risk for CKD in accordance with the recommendations provided. METHODS: The study included 460 patients who visited their doctor at least once in the three-year period. Data on blood pressure, ACEI use, estimated glomerular filtration rate (eGFR) and comorbidities were taken from patients' medical records. RESULTS: Blood pressure was not recorded in any of the three years in 42.8% and eGFR in 36.7% of the patients, but blood pressure was registered every year in 7.8% and eGFR in 4.3% of them. Over the three years, the relative number of patients with recorded blood pressure decreased from 41.7% to 17.8%, and with recorded eGFR from 41.7% to 21.5%. Multivariate linear regression found that Health Center, systolic and diastolic blood pressure and presence of hypertension were negatively associated with number of years with recorded blood pressure. Health Center, systolic blood pressure and sum of years with recorded eGFR below 60 ml/min/1.73m2 were associated with number of years with recorded eGFR. CONCLUSIONS: Under-recording of blood pressure and eGFR in primary care health centers suggests lack of adherence to current guidelines and insufficient care of CKD patients. This implies the necessity for continuous education of physicians.

Randomized prospective trial of hyperbaric oxygen therapy and intratympanic steroid injection as salvage treatment of sudden sensorineural hearing loss.

OBJECTIVE: To compare the effects of hyperbaric oxygen (HBO) and intratympanic (IT) steroid injection on hearing after the failure of primary treatment in patients with idiopathic sudden sensorineural hearing loss (ISSHL). STUDY DESIGN: A prospective randomized trial. SETTING: Tertiary referral center. PATIENTS: Fifty patients with failure of primary therapy for ISSHL. INTERVENTION(S): After primary treatment with systemic steroids and failure of therapy, defined as less than 10-dB hearing gain, 50 patients were enrolled in the study and received either hyperbaric oxygen or intratympanic steroid treatment. The patients were not matched and not similar. MAIN OUTCOME MEASURE(S): Hearing gain at 0.25, 0.5, 1, 2, and 4 kHz after treatment. RESULTS: There were significant differences between hearing thresholds at all frequencies before and after the HBO treatment. Similarly, there were significant differences between hearing thresholds at most frequencies (except 2 kHz) before and after the treatment in the IT group. The subgroups of patients with pure tone average less than 81 dB and were younger than 60 years had better response to HBO treatment than those with profound deafness and in the elderly. CONCLUSION: HBO and IT steroid therapy could be successfully used as salvage therapies in patients with sudden deafness. Further study is needed to demonstrate superiority of one of the treatments.

Management of complication from temporal bone fractures.

The objective of the study is to review clinical findings and outcomes in patients with temporal bone fractures, and to show an incidence and management of complications. It is the retrospective clinical study and the study took place at tertiary referral center. Fifty-two patients with temporal bone fractures. Data were collected from patients' charts and clinical review. Patients were classified into five groups according to the CT scan. The primary endpoint of study was to show management of possible complication from temporal bone fractures and to analyze association with intracranial injuries. The second endpoint was to show incompleteness of traditionally classification of fracture type. Of the 52 patients with 54 fractures, 27 (50%) had longitudinal fractures, 4 (7.4%) had transverse fractures, 17 (31.5%) had temporal squama-mastoid fractures, 4 (7.4%) had mixed fractures and 2 (3.7%) had isolated meatal fracture. Fifty-eight percent of patients had at least one intracranial pathologic finding, of which 11% had two or more. Persistent conductive hearing loss was noted in 8 of 16 affected patients. The facial paralysis occurred in seven patients. One patient had benign paroxysmal positional vertigo developed 3 weeks after injury. In conclusion, rarely temporal bone fractures are isolated injures. The squama-mastoid fracture in most cases associated with intracranial injuries. Coordination between the neurosurgeon and otologist is essential in the care of such patients. Further large studies will be done to give a more complete classification of temporal bone fractures which will include all fracture patterns and predict clinical outcome.

Vocal fold mucosa "blue lines" observed on contact telescopy at Reinke's edema.

Reinke's space is a highly specific structure critical for the function of the vocal fold, involved in a majority of pathological changes of the larynx. The aim of the study was to contribute to the understanding of edematous areas of vocal fold mucosa in patients with Reinke's edema using contact telescopy (ConTel). The edematous tissue which could be identified grossly by microlaryngoscopy under general anesthesia was stained topically with methylene blue and then examined using ConTel. The observed changes on contact images were further correlated with corresponding histological sections of biopsied edematous tissue. In patients with Reinke's edema examined using ConTel, we observed longitudinal arranged mucosal "blue lines" (BL). In the histological sections of edematous tissue showing the BL on ConTel, we almost regularly observed well-developed hollow spaces in subepithelia. Also, they were regularly oriented from the middle of the membranous portion of the vocal fold toward the arcuate line distributed almost parallel to the free edge of the vocal fold. BL were a specific feature of Reinke's edema as they were not found in control groups with normal vocal fold mucosa and with vocal fold polyps. For the first time we are describing a new superficial morphological feature of Reinke's edema. The BL could present epithelial ConTel markers of the area between two enlarged neighboring subepithelial crevices of Reinke's space, as indicated on histological sections. Further characterization of BL is required for the understanding of their role in Reinke's edema.

Giant funicular intrapharyngeal schwannoma.

BACKGROUND: Schwannoma is a rare solitary tumor of Schwann cell origin. The Schwann cell surrounds peripheral nerve tissue and is believed to originate from neural crest. Surgery presents main treatment for patients with schwannoma. METHODS: This is a report of a rare case of giant and bizarre-shaped intrapharyngeal schwannoma. A 38-year-old woman with a very large schwannoma (25 cm x 6 cm x 4 cm), which gradually increased in size and with a progressive dysphagia, is presented. RESULTS: Schwannoma was detected by clinical and endoscopic examination and also with CT scan. Complete resection was achieved by external approach surgery. CONCLUSIONS: The advantage of the lateral pharyngotomy with tracheotomy for complete excision of a mass is demonstrated. It provides an excellent operative exposure and recovery without impairment of breathing and deglutition.

Detection of Helicobacter pylori in nasal polyps: preliminary report.

OBJECTIVE: Investigation of Helicobacter pylori (HP) colonization in the nasal polyp specimens of patients with chronic rhinosinusitis (CRS). DESIGN: A prospective clinical trial. SETTING: The study was performed in 23 adult patients with sinonasal polyposis and 15 controls with concha bullosa (CB) who underwent endoscopic sinus surgery. METHODS: In all patients, gastroesophageal reflux (GER) symptoms were evaluated, and in 30 of them, the HP status of the stomach was also studied. Nasal polyps, mucosa of the middle concha, and gastric specimens were analyzed using a urease test and by Giemsa staining. MAIN OUTCOME MEASURES: We found HP in nasal polyp specimens in six CRS patients by the urease test and by histochemical analysis with Giemsa staining. RESULTS: All of them had HP in gastric specimens and GER symptoms. HP was not detected in any patient with CB. CONCLUSIONS: These results may have implications for a possible role of HP in CRS with polyposis. If a patient has HP in his gastric mucosa and is positive for GER symptoms, HP may be found in polyps as well. Whether HP is one of the causative agents of CRS or is a result of CRS is not known. Further studies are needed to find an answer to these questions.

[Significance of ultrasound and ultrasound-guided fine-needle aspiration for the detection of laryngeal occult metastases].

BACKGROUND/AIM: To evaluate ultrasound criteria based on a node size, shape, vascularity and cytology findings with respect to their value for the comparative determination of metastatic lymph nodes in laryngeal carcinoma. METHODS: A prospective study included 30 patients with laryngeal squamous cell carcinoma without node enlargement on computerized tomography, at the Department of Otorhinolaryngology, the University Hospital, Zemun. Thirty-six neck lymph nodes were evaluated sonographically and aspirated with an ultrasound-guided fine-needle. They were examined cytologically and/or histopathologically and compared to the sonographic assessment of their malignancy. RESULTS: Of the 36 neck lymph nodes evaluated cytologically, the 13 were found to be with a metastatic deposit. The assessment of a lymph node malignancy using the parameter of size had the senzitivity of 84%, the specificity of 70%, and the reliability of 75%. Using the criteria of a lymph node shape for the assessment of malignancy, the sensitivity of 61%, specificity of 65%, and the reliability of 64% were achieved. The evaluation of a lymph node vascularity by the use of the effect of Doppler showed the sensitivity of 69%, the specificity of 95%, and the reliability of 86%. CONCLUSION: Ultrasound and ultrasound-guided fine-needle aspiration citology should be always used for the preoperative staging and for the postoperative follow-up of the status of the neck with cancer of the larynx becouse of their high accuracy, availability and semiinvasivity, and in order to enhance the reliability of the evaluation of the malignant disease progression.

Trichinella spiralis and laryngeal carcinoma: a case report.

An uncommon presentation of Trichinella spiralis with squamous cell carcinoma of the larynx is reported. The possible carcinogenic potential of trichinosis and its management are discussed.

Seismic risk assessment and measures for reduction of earthquake consecuences in urban regions

The increasing urbanization and the enormous growth of urban regions accompanied by a high concentration of population is greatly influencing the level of seismic risk although there are no any changes in the seismic hazard the considered region is exposed to. Regarding to these considerations, this paper is presenting an integrated model for assessment of the seismic risk, generally based on seismological and instrumental data, regional and local studies as well as damage data and experiences obtained from past earthquakes that can be transmitted in the region under consideration. Correct engineering estimation of the seismic risk level a given region is exposed to, enables the engineers, urban planners, public policy makers and administrators to elaborate in advance proper safety plans for an inmediate rehabilitation and investigation of the affected region or to elaborate a seismic protection plans in orden to mitigate the possible consequences. The paper is also discussing in general the pre-earthquake and post-earthquake measures and activities that should be undertaken by the society in order to dicrease the vulnerability and mitigate the seismic risk. Also, basic criteria for design of earthquake resistant structures are presented in order to underline the engineering approach for reducing the overall vulnerability level of new developments. The Appendix to this paper summarizes the earthquake damage and usability classification of buildings developed and later emplyed during the Montenegro, Yugoslavia earthquake of April 15, 1979(AU)

Modelo para la evaluación de la vulnerabilidad y el riesgo sísmico

Presenta un modelo integrado de predicción para la evaluación a gran escala del daño sísmico regional/urbano basado en datos sismológicos e instrumentales, estudios regionales y locales y registros de daños provenientes de terremotos anteriores. Se analiza y presenta un aspecto general a largo plazo de un programa regional de reducción de riesgo sísmico estudiando dos situaciones hipotéticas de utilización de terreno en el mismo ambiente sísmico