European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Head and Neck Module, updated version: Preliminary psychometric data from Serbian laryngectomized patients.

BACKGROUND: We provided preliminary psychometric data for the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Head and Neck Module, updated version (QLQ-H&N43) from a group of Serbian laryngectomized patients. METHODS: The study included 170 subjects. The QLQ-H&N43 is a 43-item questionnaire, with 12 multi-item scales and 7 single-item symptom scales. All subjects also completed the Quality of Life Questionnaire-Core 30-questions (QLQ-C30). RESULTS: Good internal consistency (Cronbach's α of above 0.7) was found for 5 of the 7 scales. All QLQ-H&N43 scales correlated negatively as predicted with all QLQ-C30 functioning scales. The correlations with the QLQ-C30 symptoms supported discriminant validity, with only one exception: the head and neck social eating scale overlapped with the QLQ-C30 pain scale. For 14 of 19 QLQ-H&N43 scale scores, significant known-group differences were observed between those who differ in type of laryngectomy, adjuvant therapy, or 5-year survival. CONCLUSION: Preliminary evidence suggests that a great majority of the QLQ-H&N43 scales have acceptable internal consistency and promising construct validity, but more research studies are needed with other cancer groups to extend these findings. © 2015 Wiley Periodicals, Inc. Head Neck 38: E916-E924, 2016.

Primary nasal tuberculosis: a case report.

INTRODUCTION: During the past two decades, tuberculosis (TBC) both pulmonary and extrapulmonary, has emerged to be a major health problem. Nasal tuberculosis is a specific inflammatory process which is, in most cases, joined by the inflammation of neck lymph nodes. CASE REPORT: Thirty-year-old man presented with shortness of breath through the nose and periodical headaches. Clinical examination showed signs of chronic rhinitis, with slight granular changes of nasal septal mucosa. Laboratory analyses were within the reference ranges. Nasal and throat swabs for bacteria and fungi were normal. Skin allergy testing to standard inhalatory allergens was positive. Computer rhinomanometry showed increased nasal resistance at medium difficulty level, on the right. Radiography of paranasal sinuses indicated chronic polysinusitis on the right. Anti-allergy therapy was prescribed. The patient came for checkup after a month with subjective deterioration and a neck tumefact on the right. Nasal endoscopy revealed the presence of dark red infiltrates with the 3 mm diameter on nasal septal mucosa, dominantly on the right, with small greyish nodules. This findings indicated a potential specific nasal inflammatory process. In the upper jugulodigastric area, on the left, painless tumefact 3 x 5 cm in size was palpated, it was mobile comparing to supra- and infrastructure, with unaltered skin above. The definite diagnosis was established on the basis of the results of nasal mucosa biopsy. After histopathological diagnosis was obtained, we started with antituberculosis therapy at once. CONCLUSION: Due to actual trends of TBC incidences, otolaryngologist should have in mind nasal TBC, when granulomatose lesions are found in nose.

Clinical outcome of early glottic carcinoma in Serbia.

OBJECTIVE: Proposed methods for treating early glottic carcinoma are cordectomy through laryngofissure, laser cordectomy, and radiotherapy. The aim of the study was to conduct comprehensive study to evaluate oncological and functional results of different treatment modalities for Tis and T1 glottic carcinoma, identify prognostic factors for the outcome of treatment and decide where we stand in applying worldwide standards of early glottic carcinoma treatment. METHODS: Prospective study was conducted on 221 patients treated with Tis and T1 glottic carcinoma from 1998 to 2003 (72 patients were treated endoscopically with CO2 laser, 75 patients with cordectomy through laryngofissure and 74 with radiotherapy), with follow-up period from 38 to 107 months. Important demographic and clinical variables were analyzed. Voice quality after the treatment was assessed using multidimensional voice analysis. RESULTS: Comparing oncological results of three modalities of treatment, there were no significant differences. Functional results of treatment were better after laser cordectomy and primary radiotherapy than following the open cordectomy. Five-year survival rate was almost identical in all three groups of patients, and important prognostic factors for survival were age and histological grade of the tumor. CONCLUSION: Considering that the choice of treatment in our country is also greatly influenced by other paramedical factors, such as distance from treatment facility, reliability of follow-up, significant time delay of radiotherapy because of small number of radiology centers and strong patients' surgeon and treatment preference, we consider endoscopic laser surgery highly efficient and preferred choice of treatment for early glottic carcinoma.

Simultaneous analysis of irbesartan and hydrochlorothiazide: an improved HPLC method with the aid of a chemometric protocol.

Experimental design method was used for HPLC determination of irbesartan and hydrochlorothiazide in combined dosage forms. The traditional approach for optimization of experiments is time-consuming, involves a large number of runs and does not allow establishing the multiple interacting parameters. The main advantages of the experimental design method include the simultaneous screening of a larger number of factors affecting response and the estimation of possible interactions. On the basis of preliminary experiments, three factors-independent variables were selected as inputs (methanol content, pH of the mobile phase and temperature) and as dependent variables, five responses (resolution, symmetry of irbesartan peak, symmetry of hydrochlorothiazide peak, retention factor of irbesartan and retention factor of hydrochlorothiazide) were chosen. A full 23 factorial design, where factors were examined at two different levels ("low" and "high") was used to determine which factors had an effect on the studied response. Afterwards, experimental design was used to optimize these influent parameters in the previously selected experimental domain. The novelty of our method lies in the optimization step accomplished by Derringer's desirability function. After optimizing the experimental conditions a separation was conducted on a Supelcosil C(18) (150 mm × 4.6 mm, 5 mm particle size) column with a mobile phase consisting of methanol-tetrahydrofuran-acetate buffer 47:10:43 v/v/v, pH 6.5 and a column temperature of 25 °C. The developed method was successfully applied to the simultaneous separation of these drug-active compounds in their commercial pharmaceutical dosage forms.

Risk factors for the appearance of minimal pathologic lesions on vocal folds in vocal professionals.

BACKGROUND/AIM: An excessive use or misuse of voice by vocal professionals may result in symptoms such are husky voice, hoarse voice, total loss of voice, or even organic changes taking place on vocal folds--minimal pathological lesions--MAPLs. The purpose of this study was to identify the type of MAPLs which affects vocal professionals, as well as to identify the risk factors that bring about these changes. METHODS: There were 94 vocal professionals who were examined altogether, out of whom 46 were affected by MAPLs, whereas 48 of them were diagnosed with no MAPLs, so that they served as the control group. All these patients were clinically examined (anamnesis, clinical examination, bacteoriological examination of nose and pharynx, radiography of paranasal cavities, allergological processing, phoniatric examination, endo-video-stroboscopic examination, as well as gastroenterologic examination, and finally endocrinological and pulmological analyses). RESULTS: The changes that occurred most often were identified as nodules (50%; n = 23/46) and polyps (24%; n = 11/46). Risk factors causing MAPLs in vocal professionals were as follows: age, which reduced the risk by 23.9% [OR 0.861 (0.786-0.942)] whereas the years of career increase the risk [OR 1.114 (1.000-1.241)], as well as the presence of a chronic respiratory disease [OR 7.310 (1.712-31.218)], and the presence of gastro-oesophageal reflux disease [OR 4.542 (1.263-16.334)]. The following factors did not contribute to development of MAPLs in vocal professionals: sex, a place of residence, irritation, smoking, endocrinologic disease and the presence of poly-sinusitis. CONCLUSION: It is necessary to introduce comprehensive procedures for prevention of MAPLs, particularly in high-risk groups. Identification of the risk factors for MAPLs and prevention of their influence on vocal professionals (given that their income depends on their vocal ability) is of the highest importance.

Cochlea and other spiral forms in nature and art.

BACKGROUND: The original appearance of the cochlea and the specific shape of a spiral are interesting for both the scientists and artists. Yet, a correlation between the cochlea and the spiral forms in nature and art has been very rarely mentioned. AIM: The aim of this study was to investigate the possible correlation between the cochlea and the other spiral objects in nature, as well as the artistic presentation of the spiral forms. METHODS: We explored data related to many natural objects and examined 13,625 artworks created by 2049 artists. We also dissected 2 human cochleas and prepared histologic slices of a rat cochlea. RESULTS: The cochlea is a spiral, cone-shaped osseous structure that resembles certain other spiral forms in nature. It was noticed that parts of some plants are arranged in a spiral manner, often according to Fibonacci numbers. Certain animals, their parts, or their products also represent various types of spirals. Many of them, including the cochlea, belong to the logarithmic type. Nature created spiral forms in the living world to pack a larger number of structures in a limited space and also to improve their function. Because the cochlea and other spiral forms have a certain aesthetic value, many artists presented them in their works of art. CONCLUSIONS: There is a mathematical and geometric correlation between the cochlea and natural spiral objects, and the same functional reason for their formation. The artists' imagery added a new aspect to those domains. Obviously, the creativity of nature and Homo sapiens has no limits--like the infinite distal part of the spiral.

Voice quality after treatment of early glottic carcinoma.

OBJECTIVES: Increasing incidence of laryngeal carcinoma and advancement in diagnostics and therapy methods, have led to constant exploration in that field. Early glottic carcinoma can be treated successfully with several procedures: cordectomy through laryngofissure, laser cordectomy, and radiotherapy. Our objective was to assess the voice quality after these different modalities of treatment. STUDY DESIGN: Prospective controlled study with 69 patients, treated in a 1-year period for glottic Tis and T1a carcinoma at the tertiary medical centre. METHODS: Nineteen of our patients were treated endoscopically with CO(2) laser (types III-IV cordectomy according to recommended European Laryngological Society classification of endoscopic cordectomies). Thirty-five patients underwent cordectomy through laryngofissure, 15 patients had radiotherapy. Multidimensional computer analysis of voice and speech was conducted 1, 6, and 12 months after the treatment. Three programs included 14 parameters, which were observed. RESULTS: While comparing the parameters between the groups, there were significant differences in the values of fundamental frequency (Hz), jitter (%), normalized noise energy (dB), standard deviation of fundamental frequency (Hz), percent silent time (%), and sound-pressure level in the different follow-up periods (P<0.05). CONCLUSION: In the long run, patients treated with radiotherapy show better voice quality in comparison with other two groups.

Speech and language disorders secondary to diffuse subcortical vascular lesions: Neurolinguistic and acoustic analysis. A case report.

BACKGROUND AND PURPOSE: Subcortical white matter (WM) plays an important role in speech production and language processing. Most frequently, cerebral WM lesions are secondary to small vessel disease in patients with vascular risk factors. We report the case of a 53-year-old man with history of hypertension and ischemic subcortical lesions, who presented with speech difficulties and mild cognitive impairment. METHODS: Language and cognitive assessment included Boston Diagnostic Aphasia Examination, Boston Naming Test, Rey Auditory-Verbal Learning Test, Rey-Osterrieth Complex Figure Test, Trail Making Test A and B, Wisconsin Card Sorting Test, Scale for Evaluation of Perceptive Characteristics of Voice and Speech, and Multidimensional Evaluation of Speech and Voice. RESULTS: Brain MRI showed ischemic WM lesions and lacunar infarcts in the brainstem and right cerebellum. Cognitive testing revealed mild cognitive impairment, predominantly affecting attention and executive functions. Speech and language analysis demonstrated dysarthria, dysphonia with hypophonia, and imprecise articulation, as well as short rushes of speech, palilalia and mild subcortical dysphasia. CONCLUSIONS: Neurolinguistic and acoustic analysis in patients with ischemic WM lesions can provide additional information in the understanding of language and speech disturbances, and can assist in patient management.

[Botulinum toxin efficacy in the treatment of patients with spasmodic dysphonia].

BACKGROUND/AIM: Spasmodic dysphonia (DS) is a disabling speech disturbance appearing as the consequence of dystonic vocal folds contraction. Its intermittent appearance in the laryngeal muscles causes vocal function discontinuation. The quality of life of these patients is significantly disturbed. Surgical and a medical therapy appear to be inadequate and unsuccessful ones of no steady improvement. It is the botulinum toxin therapy that proved to be highly efficacious one, with the established improvement in 80-100% of patients. The aim of our study was to evaluate the efficacy of botulinum toxin therapy in patients with SD and to show our preliminary results. METHODS: The study included 10 patients with adductor spasmodic dysphonia. After diagnostic procedures, botulinum toxin was applied either in one or both vocal folds, in doses of 12-16 units each. In our study we applied indirect technique originally developed by Hocevar and Pirtosek. Perceptive voice and speech analysis was performed prior to and after the instillation of botuline toxin as per structured Scale of pathological characteristics of voice and speech appearing in the spasmodic dysphonia. RESULTS: The majority of our patients experienced both subjective improvement and the improvement in the terms of the quality of life, Voice Henolicap Index--(VHI) that was rated as rather significant one (t = 3.562; p = 0.006). CONCLUSION: Regardless unquestionable improvement of definite phonation, further function restitution requires individual vocal therapy and psychotherapy. Vocal therapy includes structural vocal techniques which reduce degree of vocal tension and rapid changes in the power and the height of voice. Further investigations are necessary for the scope of the definition of a standardized therapeutically procedure for spasmodic dysphonia treatment which comprises multidisciplinary approach in diagnosis, therapy and treatment efficacy evaluation.