Quality of life and mental health of volunteers during COVID-19 pandemic: a cross-sectional survey in Serbia.

OBJECTIVE: There is a paucity of information on the COVID-19 pandemic's impact on young volunteers. Therefore, the aim of this survey was to examine the QoL and mental health of young volunteers of the Novi Sad Voluntary Service during the COVID-19 pandemic. PATIENTS AND METHODS: This cross-sectional prospective study included 255 members of the Novi Sad Voluntary Service, Serbia. The survey instrument probed into the respondents' demographic characteristics and was followed by the anonymous WHOQOL-BREF questionnaire that measured their quality of life during the COVID-19 pandemic and DASS-21 scale. All statistical analyses were carried out using IBM SPSS Statistics for Windows, vers. 24.0. RESULTS: The study sample consisted of 255 young volunteers (71.4% females, 28.6% males), 62.0% of whom were aged 18-25 years, and 52.2% were students. Lower Physical Capacity scores could be predicted by female gender (p < 0.01) and COVID-19 infection among friends (p < 0.05). Male gender (p < 0.05) and being employed (p < 0.05) predicted greater QoL in the Psychological domain. The only predictor of a lower QoL in the Social Relationships domain was the internet as the main COVID-19-related information source (p < 0.05). On the other hand, being female (p < 0.05) and having COVID-19-positive household members (p = 0.01) predicted lower environment domain scores. For the lower overall DASS-21 score, having COVID-19-positive household members was the only significant predictor (p < 0.01). CONCLUSIONS: Mental health support should pursue strategies to improve all domains of QoL, especially for vulnerable sub-groups of the population, such as young females and the unemployed. Bearing in mind the importance of public engagement and community support in pandemic circumstances, as well as generally in public health, these results are relevant for interventions far beyond the current pandemic.

Paraoxonase 1 low activity and SYNTAX score may predict postoperative complications after coronary artery surgery.

OBJECTIVE: Coronary artery bypass grafting (CABG) seems to present a powerful trigger of oxidative stress (OS) and acute inflammatory response. This study aimed to estimate the effects of off-pump coronary artery bypass (OPCAB) grafting on the OS that is commonly observed in patients undergoing operation under cardiopulmonary bypass (CPB). Additionally, we aimed to examine the relationship between and paraoxonase 1 (PON1) activity and the degree of stenosis, severity and complexity of the atherosclerotic lesions, estimated by SYNTAX score (SS). PATIENTS AND METHODS: Study group of 107 patients scheduled for CABG were divided into CPB and OPCAB group. Blood samples for OS markers measurement were collected at six-time intervals: before skin incision (t1), immediately after surgery (t2), 6h (t3), 24h (t4), 48h (t5) and 96h after cessation of the operation and surgical trauma (t6). SS was calculated. RESULTS: A significant decrease in lipid hydroperoxides (LOOH) and advanced oxidation protein products (AOPP) levels after both types of surgeries were observed, whereas PON1 reduction was observed higher in the CPB than in the OPCAB group. A significant inverse correlation between SS values and PON1 activity, preoperatively and during the early postoperative hours after surgery [in t2, t3 time intervals (p<0.05 for all)] was found. ROC analysis showed that for CPB patients, Model with all OS parameters showed excellent accuracy (AUC=0.957, p<0.001) for prediction postoperative complications. CONCLUSIONS: Decrease in PON1 activity during the early post-operative phases was related to higher SS. This relationship was more convincing in CPB, compared with OPCAB patients. Moreover, integrated models of OS status parameters have the capability to predict the development of postoperative complications.

Safety of vaginal erbium laser: A review of 113,000 patients treated in the past 8 years.

Background: Energy-based devices are becoming a popular option for minimally invasive vaginal procedures. The aim of this study was to obtain information on the frequency of occurrence of adverse effects (AEs) related to vaginal erbium laser (VEL™) treatment.Materials and methods: The global survey was conducted among practitioners using the non-ablative VEL™ (Fotona, Ljubljana, Slovenia). Users were invited to provide the number of patients treated with VEL™ and the number of observed laser-related AEs.Results: The survey was conducted from August 2018 to April 2019. Responses from 535 practitioners were collected, with a total of 113,174 patients treated in the period from 2012 to 2019. Out of 535 respondents, 160 (30%) shared detailed information about the indications they treated in a population of 62,727 patients, whereas 188 (35%) respondents provided information on the frequency of AEs observed in their treated population of 43,095 patients. All observed AEs were mild to moderate, transient and appeared with low frequencies.Conclusions: Minimally invasive thermal-only laser treatment using the non-ablative VEL™ procedures appears to be safe and the incidence of AEs is low.

Inheritance of quantitative traits in crosses between two Pisum sativum subspecies with particular reference to their breeding value.

The experimental study was conducted during the period of 2008-2010 at the experimental field of the Institute of Forage Crops in Pleven. The hybridization scheme included direct and back crosses covering four varieties of forage pea (Pisum sativum L.), namely two spring ones, Usatii 90 and Kamerton from Ukraine, and a winter one from Bulgaria, Pleven 10. There was analyzed the inheritance of quantitative traits such as plant height, height to first pod, pod number per plant, seed number per plant, seed number per pod, seed weight per plant and number of fertile nodes per plant of parental components (P1 and P2) and both first (F1) and second (F2) hybrid generations. The cross Usatii 90 x Pleven 10 showed the highest real heterosis effect for plant height (8.26%), pods per plant (158.79%), seeds per plant (272.16%), seeds per pod (42.09%), seed weight per plant (432.43%) and number of fertile nodes per plant (117.14%). The cross Pleven 10 x Usatii 90 had the highest real heterosis effect height to first pod (11.06%). In F2 plants, the strongest depression for plant height (5.88%), seeds per plant (57.88%), seeds per pod (55.93%) and seed weight per plant (55.99%) was in the cross Usatii 90 x Pleven 10, for height to first pod (1.47%) in the cross Kamerton x Pleven 10 and for number of fertile nodes per plant (15.91%) in the cross Pleven 10 x Usatii 90. The highest positive degree of transgression for number of fertile nodes per plant (165.64%) and seed weight per plant (162.10%) was in the cross Pleven 10 x Kamerton and for pod number per plant (102.54%) and seeds per plant (99.13%) in Kamerton x Pleven 10. The stability of the characters was determined. Low variability in F1 and F2 was found in plant height (3.97-6.85%). Variability of number seeds per plant in F1 was highest (11.86-33.23%). For all other traits, the variability varied from average to high. A lower narrow-sense heritability coefficient was observed for plant height, height to first pod, pods per plant, seeds per plant and seed weight per plant (from 0.001 to 0.230). In few cases, such as in fertile nodes per plant (0.39 and 0.81) and seeds per pod (0.44), the coefficients ofbroad-sense heritability were higher.

Towards the re-introduction of grass pea (Lathyrus sativus) in the West Balkan Countries: the case of Serbia and Srpska (Bosnia and Herzegovina).

Vetchlings (Lathyrus spp.) are widely distributed in both Serbia and Srpska, and represent a valuable component of local floras all over the Balkan Peninsula. Despite this and the existence of a traditional Serbian name for grass pea (Lathyrus sativus L.), sastrica, and a pan-Slavic name for all vetchlings, grahor, today they are almost forgotten crops. The joint action of the Institute of Field and Vegetable Crops and the Faculty of Agriculture is aimed at re-introducing grass pea and other vetchlings as multifunctional crops. Within the legume collection in the Institute of Field and Vegetable Crops, a small Lathyrus spp. collection, including about 100 accessions of 16 species, most of them being grass pea, was established in 2002. The landraces of grass pea were collected in several regions of Serbia and Srpska, where they are used for human consumption. Grass pea is commonly used boiled and along with other pulses, with no reports on lathyrism among the local people. The first Serbian breeding programme in Novi Sad produced already two grass pea lines that were registered in November 2009 under the names of Studenica and Sitnica, developed from the crosses of Polish cultivars and local Serbian landraces.

Parapharyngeal space tumors: 61 case reviews.

Parapharyngeal tumors account for 0.5% of head and neck tumors. They are difficult to diagnose because they have few symptoms and are surgically inaccessible. This retrospective study included 61 patients with parapharyngeal space tumors, treated in the last 20 years. The data, obtained from the medical records, included symptoms and clinical signs, diagnostic procedures, surgical approach, postoperative complications and histopathological findings. The most common symptoms were dysphagia, foreign body sensation, pain, and symptom-free patients. For precise tumor localization and its relation to adjacent structures, computerized tomography, magnetic resonance imaging and contrast angiography were used. All the patients were treated surgically. The commonest surgical approach was transcervical, followed by transoral and combined transcervical-transoral. Histopathological examination verified that the origin of these tumors was most frequently salivary or neurogenic.

Polyhydramnios and bone development: an unexplored relationship.

Immersion of a humans and Macaca mulatta into a pool with fluid whose specific weight is equal to their specific weight cause bone demineralization. Also, in professional scuba divers, bone mineral density is reduced. Because of water immersion, the apparent weight of scuba divers represents 10% of their actual weight. The aim of this paper was to point out a previously unexplored aspect of fetal bone development in an environment lacking adequate mechanical stress on fetal bone, such as polyhydramnios. In the first part of gestation, the human fetus develops under conditions similar to neutral floating and has an apparent weight which is approximately 5% of its actual weight. During the last trimester of gestation, the fetus overgrows the intrauterine cavity and its apparent body weight is 60-80% of its actual weight. Polyhydramnios represents an excess of amniotic fluid in the uterus during gestation and it can reduce the apparent weight of the fetus to 10-20% of its actual weight. Reduction of the mechanical stress on fetal bone caused by polyhydramnios may significantly affect bone development and ossification during the last trimester of gestation. It is necessary to direct further studies towards examining bone development and mineralization in newborns from gestations complicated by polyhydramnios. A complete lack of data and studies on fetal bone development and bone mineralization in pregnancies complicated by polyhydramnios is not surprising. There is still a misleading opinion that the fetus is in weightlessness condition in the intrauterine environment throughout the second half of gestation regardless of the amount of amniotic fluid.

Shoot development from hypocotyl protoplasts of sunflower (Helianthus annuus L.).

The plant regeneration from sunflower protoplast was achieved by protocols that considerably differ with respect to basal medium and concentration of growth regulators added. In most cases regeneration was restricted to a small proportion of genotypes. In this experiment, sunflower inbred line Ha-74A, with a high regeneration ability was used for protoplast isolation from etiolated hypocotyls. Isolated protoplasts were embedded in agarose droplets and cultured according to different regeneration protocols. The best results were obtained when protoplasts were cultured on L4 medium followed by transfer of regenerated microcalluses to solid regeneration media. Shoot regeneration was achieved by culture of calluses on SE regeneration medium after the treatment with 2.2 µM thidiazuron.

[Analyses of the results in the treatment of locally advanced hypopharyngeal carcinoma with different therapeutic approach].

INTRODUCTION: treatment of locoregional advanced hypopharyngeal cancers of grades III and IV would be surgery and/or radiotherapy. An increasing number of authors has emphasized favorable effects of neoadjuvant chemotherapy and radiotherapy with potentiation. THE AIM: the authors presented therapeutical results of three-year survived patients with squamocellular cancers of the hypopharynx (SCC Hy), grades III and IV, in relation to specific modalities of therapeutical approach. METHODS: a series of 207 patients with grades III and IV of SCC Hy, treated in the period 1982 to 2002, was analyzed. Group I consisted of 131 patients who had surgery and postoperative radiotherapy (SUR-RT). Group II included 16 patients who underwent induction chemotherapy, surgery and postoperative radiotherapy (IC-SUR-RT). Group III consisted of 60 patients, who had primary radiotherapy (RT). Group IV involved 29 patients who were treated, in the period 2003-2006, by neoadjuvant chemotherapy followed by radiotherapy with potentiation (CHT-RT). RESULTS: three-year survival in Group I was 67.94%, Group II--50%, Group III--30%, and in Group IV was 51.72%. Five-year survival was analyzed only in group I-III. The longest survival was observed in Group I--33.59%. CONCLUSION: the best therapeutical results were achieved in patient group that was primarily operated on and then had postoperative radiotherapy, while the worst survival was recorded in patients who had primary radiotherapy.

Nonvibrating segment predicting glottis carcinoma.

Endovideolaryngostroboscopy is the obliged evaluation tool in our everyday practice. Standardized protocol in management of broad spectrum of vocal pathology is useful in clinical, scientific and educational evaluation of patient from the first interview till the end of the treatment. Using of contemporary computerised multidimensional analysis of stroboscopic image we are approaching to optimum evaluation of any kind of interpersonal communication disorder. There were 66 patients in prospective clinical study of correlation between suspect endovideolaryngostroboscopic findings and histo-pathology verification of glottis carcinoma. Asymmetric and irregular vibrations with absent mucosal wave or absent vibrations of one part or of the whole vocal fold was improved as carcinoma in 85% of patients. The most frequent diagnosis was Ca planocellularae invasivum G2 NG 2, with subsequent open chordectomy. In every case of hoarseness longer more than 14 days, endovideolaryngostroboscopy is the golden standard for evaluating the need for microlaryngoscopy and biopsy.

[The role of functional sinus surgery for treatment of antrochoanal polyp].

UNLABELLED: Antrochoanal polyp (ACP) is a benign lesion which arises from the mucosa of maxillary sinus, fills it and expands through natural ostium towards choana protruding in the epipharynx. OBJECTIVE: to present our experience in endoscopic surgery of ACP. MATERIAL AND METHODS: prospective study included 24 patients operated at the Institute of Otorinolaryngology and Maxillofacial surgery, Clinical Center of Serbia, Belgrade, in the period 2002-2004. Subjective symptoms, endoscopic and CT findings were evaluated postoperatively, following up the patients in the period 12-20 months. Subjective difficulties of patients were tested by 100mm-analogue scale, while endoscopic and CT findings were demonstrated by three-stage scale from 0 to 2. Applying the technique of ACP extraction in Trendelenburg's position and approaching the part which protrudes in the epipharynx, we successfully removed the endonasal part by means of curved forceps for epipharyngeal biopsy. By endoscopic middle meatotomy, the natural ostium of maxillary sinus was expanded and pathological process from the very sinus was successfully removed. RESULTS: only one female patient had the majority of symptoms after the operation, while all others had no complaints. Endoscopic and CT findings were normal in all patients at the latest control, without any signs of ACP recurrence. There were no intraoperative or postoperative complications. CONCLUSION: minimal damage to sinus mucosa due to forceps is lesser problem than complications developed upon creating even the miniature opening in the canine fossa. Using this technique, a dexterous surgeon may successfully extract patho-logical process with minimal incidence of recurrence, and, more important, with no complications and maximally fast recovery of patients.

Posterior leaflet preservation during mitral valve replacement for rheumatic mitral stenosis.

Mitral valve replacement with posterior leaflet preservation was shown beneficial for postoperative left vetricular (LV) performance in patients with mitral regurgitation. Some authors find it beneficial even for the long term LV function. We investigated a long term effect of this technique in patients with rheumatic mitral stenosis. We studied 20 patents with mitral valve replacement due to rheumatic mitral stenosis, in the period from January 1988 to December 1989. In group A (10 patients) both leaflets and coresponding chordal excision was performed, while in group B (10 patients) the posterior leaflet was preserved. In all patients a Carbomedics valve was inserted. We compared clinical pre and postoperative status, as well as hemodynamic characteristics of the valve and left ventricle in both groups. Control echocardiographyc analysis included: maximal (PG) and mean (MG) gradients; effective valve area (AREA); telediastolic (TDV) and telesystolic (TSV) LV volume; stroke volume (SV); ejection fraction (EF); fractional shortening (FS) and segmental LV motion. The mean size of inserted valve was 26.6 in group A and 27.2 in group B. Hemodynamic data: PG (10.12 vs 11.1); MG (3.57 vs 3.87); AREA (2.35 vs 2.30); TDV 126.0 vs 114.5); TSV (42.2 vs 36.62); SV (83.7 vs 77.75); EF (63.66 vs 67.12); FS (32.66 vs 38.25). Diaphragmal segmental hypokinesis was evident in one patient from group A and in two patients from group B. In patients with rheumatic stenosis, posterior leaflet preservation did not have increased beneficial effect on left ventricular performance during long-term follow-up. An adequate posterior leaflet preservation does not change hemodynamic valvular characteristics even after long-term follow-up.

[Onco-surgical significance of anatomo-morphological specificity of glottic region of the larynx]. / Onkohirurski znacaj anatomo-morfoloskih specificnosti glotisne regije larinksa.

Glottis is a medium level of the larynx, involving the vocal cords, vocal process of arytenoid cartilage, and the anterior and posterior commissures. This region of heterogeneous histomorphological structure has specific characteristics: the internal striated muscles, the outer and inner perichondrium, atypical intra-cartilaginous areas of ossification, and unusual muscular insertion to cartilage. Microtomy of 3 thick successive sections was performed at the level of the upper surface of vocal cords. Standard histological staining methods were used. Microphotographs were taken by light microscope under different magnification along with histomorphometric measurements. Cancer spread is partially restricted by anatomic barriers: vocal ligament and tendon of the anterior commissure, and subsequently by the elastic cone. Easier tumor extension may be due to absence of the internal perichondrium and ossification of thyroid cartilage. Microvascularization of the anterior commissure is significant for tumor spread in glottis and paraglottic space. The role of commissural lymph network in local spread of the cancer is completely vague. It is certain that there are causes, still unrecognized, which have an effect on the pathways and direction of malignant tumor spread.

[Extended supra glottic laryngectomies]. / Prosirene supraglotisne laringektomije.

In the period 1976-1998, 408 patients with supraglottic laryngeal cancer were primarily treated by surgery using the method of supraglottic laryngectomy. Classical supraglottic laryngectomy was performed in 355 patients, while 53 underwent extended supraglottic laryngectomy. The objective of the study was to analyze the success of the extended supraglottic laryngectomy in relation to classical supraglottic laryngectomy in indicated cases. T1 tumor was found in 171 (42%) patients, T2 in 212 (52%), while T3 was found in 25 (6%) cases. Local recurrence developed in 3 out of 53 patients operated by the extended supraglottic laryngectomy technique, and in 17 out of 355 operated by classical supraglottic laryngectomy (chi2=0.075, DF=1, p=0.784; Yates=0.00, p=1.00). Five-year survival of patients operated by the extended supraglottic laryngectomy was reported in 40 out of 53 patients, while survival of patients operated by classical supraglottic laryngectomy was noted in 270 out of 355 cases (chi2=0.004, DF=1, p=0.926; Yates=0.00, p=1.00). There was no significant difference of local recurrence and five-year survival between patients treated by classical and extended supraglottic laryngectomy.

[Surgery treatment of laryngeal carcinoma T1]. / Hirursko lecenje T1 karcinoma glasnica.

The early stage cancer of the glottis, including Tis, T1a and T1b stages, are the most common forms with the incidence rates ranging from 25% to 85%. The therapy of early glottic cancer is usually successful for two reasons. First, true glottic cancer produces early symptoms and it is relatively easy to remove. Second, glottis is rather poor with lymph pathways so the regional metastases are rare, less than 1%. Due to role of the larynx in phonation, respiration and swallowing, the cancer of this region and its treatment has a great impact to the quality of life. Retrospective study involved ten-year period, from January 1990 to January 2004. At the Institute for Otorhinolaryngology and Maxillofacial Surgery, Clinical Center of Serbia, 858 surgical and 54 endoscopic CO2 laser-assisted resections were performed for glottic cancers of larynx of Tis-T2 stages. Glottic tumors were treated by Types III, IV and Va chordectomies according to classificaiton of endoscopic chordectomy defined by the European Laryngological Society. Analyzing the operated patients, as well as the type of the applied surgery, that is, endoscopic-laser and classic surgery, the authors attempted to clarify the dilemmas relating to the indications for one or another type of surgical intervention. The patients who had undergone primary radiotherapy were excluded from the analysis.

[Modern diagnostic procedures of nasopharyngeal carcinoma]. / Savremene dijagnosticke procedure karcinoma nazofarinksa.

The aim of this study is a research of single photon emission tomography (SPET) values with talium 201 and tehnetium 99m MIBI, comparing it with other methods CT, MRI and ultrasonography. In our investigation there were two groups of patients 24 treated with T1-201 and 17 with Tc-99m-MIBI. Before the therapy 7 patients had been tested with T1 201 and was 100% proved the sensibility, specificity, sensitivity and also 6 patients as really positive TP and 1 patient really negative TN. The same result was gotten in the group where TC 99m was used, where 3 of them were really positive and 1 negative. All discoveries were confirmed pathohistologically and leaning on this we determined the status of really positive and really negative patients. After the therapy there were 7 positive and 7 negative patients, and also one positive, and 2 negatives that were false, who were treated by thalium. On the basis of formula of sensibility these findings show that 77,8%, if it observed only a group of patients who were being tested after the therapy, while all sensibility of methode is 86.7%, where in the analise was included a group of patients at whom was registred the primary tumor. The specificity of the method for this group of patients after the therapy is 87.5%, and the whole 88.9% where the accuarsy is 82.4% in the group after therapy and the whole is 87.5%.

[Occult metastases of oral cavity cancers]. / Okultne metastaze karcinoma usne duplje.

Despite new approaches to treatment and lower mortality, malignant tumors of the head and neck, including the malignant tumors of the oral cavity, still represent significant oncological problem because long-term survival has not been significantly prolonged. The growth of tumors of this localization is fast and infiltrative, while early metastases of regional lymph nodes are rather frequent. Malignant tumors of the oral cavity account for 1.1% of population in our community (Dimitrijvic, 2001). The objective of the study was to analyze regional metastases of the cancers of the tongue and the floor of mouth in 101 patients with planocellular cancers treated in the period 1991 to 1995. Clinically positive regional lymph nodes were found in 67.3% of patients, while the most commonly involved regions were submandibular (47.4%) and upper jugular region (46.1%). They were more frequent in localization of the floor of mouth than in case of tongue cancer. Three types of neck dissections were used for surgical treatment of patients. In the group of patients with clinically negative results of the neck (N0) who underwent neck dissection, occult metastases of regional lymph nodes were verified pathohistologically in 19.2% of the time. Malignant tumors of the oral cavity are always the indication for neck dissection, even in N0 category, on account of high proportion of occult metastases.

[Distribution of cervical metastases from carcinoma of the cervicofacial region]. / Distribucija cervikalnih metastaza karcinoma cervikofacijalne regije.

The primary goal in the therapy of patients with cervico-facial cancers has been always the control of loco-regional disease. It is more difficult to control metastasis than primary tumor. According to numerous authors, metastases to cervical lymphonodus reduce the survival of patients with planocellular cancer of the upper aero-digestive pathways for about 50%. Precise classification of primary tumor and regional lymphonodus is highly significant for adequate and timely treatment of patients with cancers of cervico-facial region. The objective of our study was to make clinical classification of cervico-facial tumors and to establish the distribution of nodes according to node groups and cervical levels. In our series of 319 subjects, T2 category of primary tumors was most prevalent accounting for 40.44%. Clinically palpable lymphonodes were found in 87.15%, with most prevalent N1 category accounting for 42.95%. The incidence of clinically negative cervical nodus (N0) was reported in 12.85%. The nodes of the upper, medium and lower jugular group were most frequent in cancers of the larynx and pharynx. In cancer of the oral cavity, submental and submandibular nodes were the most commonly involved. In distribution of nodes based on oncological cervical levels, 45.86% of nodes at level II of the neck were found in laryngeal cancer, while 40% the neck level I was involved in the cancer of the oral cavity. In epipharyngeal cancer, 3.15% of cervical metastases were detected in the posterior triangle of the neck. The incidence of cervical metastases in specific primary localizations has a significant role for indications of one of the dissections of the neck.

Use of high-dose cytarabine to enhance cisplatin cytotoxicity-effects on the response and overall survival rates of advanced head and neck cancer patients.

UNLABELLED: It has been reported that cytarabine, acting by at least two different mechanisms, enhances the cytotoxic effect of cisplatin in in vitro systems. The aim of this open, prospective, randomised study was to estimate the eventual benefits from the inclusion of high-dose cytarabine in the cisplatin-5-fluorouracil (5-FU) regimen as first-line treatment of patients with advanced head and neck cancer. The study recruited successive patients with unresectable grade I/II head and neck cancer who were not suitable for irradiation treatment (T any N3 or T4 N2C), metastatic or previously irradiated. All patients gave their informed consent. A joint ear, nose and throat (ENT) oncological committee performed the selection. A total of 170 patients were included in the study. Patients randomised to arm A were given 1000 mg/m(2) cytarabine on day 1 preceding for 6 h cisplatin infusion, 30 mg/m(2)/24 h cisplatin intravenous (i.v.) bolus days 1-4 and 1000 mg/m(2)/24 h 5-FU in a 4-h infusion on days 1-4. Patients in arm B were given cisplatin and 5-FU in the same dosage and schedule as in arm A. Additional irradiation+/-surgery was performed if and when feasible. Patients in both arms were well balanced with regard to clinical variables. The following results were obtained: Arm A: 84 patients were included, 74 were evaluable for activity; RESPONSE: complete response (CR) 8 (11%), partial response (PR) 40 (54%), stable disease (SD) 11 (15%), progressive disease (PD) 15 (20%). The overall response rate (RR) based on the evaluable patients was 48/74 (65%, 95% confidence interval (CI) 54-75%); The RR based on an intent-to-treat analysis was 57%, 95% CI 47-67%; Median survival was 13 months; There were 50 episodes of granulocytopenia grade IV and 15 of febrile neutropenia per 316 cycles. Arm B: 86 patients were included, 80 were evaluable for activity; RESPONSE: CR 7 (9%), PR 29 (36%), SD 10 (12.5%), PD 34 (42.5%); The overall RR based on the evaluable patients was 36/80 (45%, 95% CI 35-56%); The RR based on an intent-to-treat analysis was 42%, 95% CI 32-52%; Median survival was 8 months; There were 14 episodes of granulocytopenia grade IV and 7 febrile neutropenias per 324 cycles. The RR was significantly higher in arm A (P=0.013), power (one-sided) 80%. The proportion of patients from the appropriate subset who achieved a clinical response making additional treatment feasible was higher in arm A (P=0.00015), as well as the proportion of patients with a performance status 2+3 achieving a response (P<0.0001). Using the Log-rank test, patients from arm A achieved a significantly longer survival (P=0.009), with the probability of survival at 12 months of 0.58 for patients in arm A and 0.28 for patients in arm B. Grade IV granulocytopenia and thrombocytopenia were more frequent in arm A. Due to its haematological side-effects, cytarabine might not be the ideal drug to modulate the cytotoxicity of cisplatin. However, other modulators of its activity could be of interest for further studies in head and neck cancer patients.

[Therapy of inflammatory changes in Bartholin's glands]. / Terapija zapaljenjskih promena Bartolinijeve zlezde.

INTRODUCTION: Bartholin's glands are bilateral structures whose function begins after puberty, so the diseases of these glands are most common during the reproductive period. Management of the inflammatory changes--abscess and cyst can be invasive and conservative, and quite often the changes become chronic, due to the failure of techniques. The aim of the study was to assess efficacy of various therapeutic approaches in the treatment of the inflammatory changes of Bartholin's glands. MATERIAL AND METHODS: The study was done at the Department of Obstetrics and Gynecology, Clinical Centre in Novi Sad, during the period 1993-1996, at the Dept. of Inflammatory Gynaecological Diseases. The total of 129 patients was treated. The first two years were analyzed retrospectively while during the years 1995 and 1996 a prospective study was done. The analysis of the therapeutic results was done according to the immediate efficacy of the therapeutic approach, incidence of recurrence, length of hospitalization and use of antibiotics. RESULTS: A total of 129 patients was treated, the mean age was 35.4 years. Cysts were treated in 14.7% and abscess in 85.3% of cases. Therapeutic approaches were different during different years. During 1993 and 1994 in majority of cases incision and complete extirpation of the glands were done, and rarely marsupialization, alone or in combination with silver nitrate (AgNO3). In 1995 and 1996 in a majority of cases incision of the gland was performed, together with the AgNO3 application (94.3% in 1995, 64% in 1996). In 1995 total gland extirpation was performed (5.7%) while in 1996 in 9 cases (36%) incision was done. The length of hospitalization was longer in earlier years, the shortest being when incision and AgNO3 application was performed (3.1/2.4 days). The use of antibiotics was significantly lower in the years when incision and AgNO3 were used. DISCUSSION: Our results are in concordance with the results of similar studies except for the fact that in our group the changes were seen more often in the age group 30-39 years. The parity was of no significance. The recurrence of the disease when this method is applied is the same as in other studies--around 3%, whereas the complications were rare. The length of hospitalization and the cost of the antibiotic therapy is of great significance as well, and they can be brought to minimum by employment of this method. CONCLUSION: The therapeutic approach of incision and AgNO3 application in therapy of inflammatory changes of Bartholin's glands is an efficient, safe, simple and cheap method, which can easily be applied in ambulatory conditions.