Korisnost radikalne disekcije nikada se ne bi dovodila u pitanje ako bi njena efikasnost bila sav... more Korisnost radikalne disekcije nikada se ne bi dovodila u pitanje ako bi njena efikasnost bila savr-{ena. Medjutim postoje onkolo{ki nedostatci pa kada im se doda postoperativni morbiditet, koji se ogleda u funkcionalnim poreme}ajima i kozmetskim nedostatcima, opravdano je tra'enje novih terapijskih pristupa. Istra'ivanjem je obuhva}eno 319 bolesnika koji su operisani u periodu od 1. januara 2000. do 31.decembra 2002. godine i konzilijarno pra}eni 5 godina od operativnog zahvata. Cilj na{eg istra'ivanja je da utvrdimo distribuciju operativnih povreda akcesorijusa kod modifikovane radikalne disekcije i odnos bolnog i spu{tenog ramena kod modifikovane radikalne i radikalne disekcije vrata. U~estalost ispitanika sa o{te}enim akcesorijusom je visoko zna~ajno redja posle modifikovane radikalne disekcije nego posle radikalne disekcije. U~estalost ispitanika se visoko zna~ajno razlikuje (χm 2 = 26.662; df = 1; p<0.01) po kategorijama komplikacija akcesorijusa (bo-lno rame, spu{teno rame) i vrstama disekcija (MRDV, RDV). Visoko zna~ajno je manje sa komplikacijama (bolno rame, spu{teno rame) posle modifikovane radikalne disekcije vrata (p<0.01). Klju~ne re~i: modifikovana radikalna disekcija vrata, n.accesorius, bolno rame UVOD K orisnost radikalne disekcije nikada se ne bi dovodila u pitanje ako bi njena efikasnost bila savr{ena. Medjutim postoje onkolo{ki nedostatci pa kada im se doda postoperativni morbiditet, koji se ogleda u funkcionalnim poreme}ajima i kozmetskim nedostatcima, opravdano je tra'enje novih terapijskih pristupa. Prve komplikacije radikalne disekcije vrata u smislu sindroma bolnog ramena zabele'ene su jo{ 1952. godine od strane Ewinga 1 i saradnika.
Background: The Voice Handicap Index-10 (VHI-10) is used in clinics because of its validity and e... more Background: The Voice Handicap Index-10 (VHI-10) is used in clinics because of its validity and ease of use by patients. Objectives: The aim of this paper was to evaluate the internal consistency, reliability, and clinical validity of the Serbian version of the VHI-10. Method: In this cross-sectional study, we translated the original English version of the VHI-10 into Serbian, after which it was back-translated into English. The Serbian version of the VHI-10 was completed by 161 patients with voice disorders, divided into 4 groups according disease etiology (structural, neurological, functional, and inflammatory) and 73 healthy control subjects. Results: The VHI-10 internal consistency was 0.88. Spearman’s rank correlation coefficient for VHI-10 test-retest reliability was ρ = 0.991 (p< 0.001). Patients with voice disorders had higher median total VHI-10 scores compared with controls (p< 0.001). The patients’ Grade, Instability, Roughness, Breathiness, Asthenia, and Strain (GI...
Malignant tumors of the oral cavity grow rapidly, frequently and early metastazing to the surroun... more Malignant tumors of the oral cavity grow rapidly, frequently and early metastazing to the surrounding regional lymph nodes. The aim of this study was to evaluate the correlation between clinically confirmed local and regional spread and intraoperatively and histopathologically verified local spread. A series of 74 patients with carcinoma of the tongue and floor of the mouth were analyzed. All the patients were surgically treated during the period 1991-1995. Clinical evidence of local spread (cT) was in high accord with intraoperatively and histopathologically evidenced spread (pT) amounting to 83.8%. The degree of correlation decreased with the increase of T stage. Clinically observed regional spread (cN) and intraoperatively and histopathologically confirmed regional spread (pN) was lower, amounting to 56.8% in comparison to the corresponding T categories.
Background/Aim. Chronic sinusitis is a disease characterized with mucosal inflammatoion of nasal ... more Background/Aim. Chronic sinusitis is a disease characterized with mucosal inflammatoion of nasal and paranasal sinuses for at least 12 weeks. In order to assess the extent and severity of inflammatory changes in paranasal sinuses CT score according to Lund-Mackay is the most commonly used. Recent studies show the possibility of existing different subtipes of chronic rhinosinusitis, pointing out the presence of nasal polyps and their influence on the severity of chronic rhinosinusitis. The aim of this research was to examine the influence of sinonasal polyposis on the extensity of inflammatory changes on computerized tomography (CT), evaluated by the Lund-Mackay CT score. Methods. A prospective study compared the Lund-Mackay CT score values between the patients with chronic rhinosinusitis associated with nasal polyps and those without them. We determined mean values of the total CT score in both groups of the patients, as well as mean values of CT score for each group of sinuses and ...
Please cite this article in press as: Banko B, et al. MRI in evaluation of neoplastic invasion in... more Please cite this article in press as: Banko B, et al. MRI in evaluation of neoplastic invasion into preepiglottic and paraglottic space. Auris Nasus Larynx (2014),
Vocal fold pathology changes the appearance and vibratory patterns observed during stroboscopic e... more Vocal fold pathology changes the appearance and vibratory patterns observed during stroboscopic examination, but a strict correlation between the vibratory pattern and the dysplasia type does not exist. The aims of this study were to determine the role of stroboscopy in vocal fold dysplasia assessment and to determine whether stroboscopy is the deciding factor when performing laryngomicroscopy with biopsy in suspicious lesions. This prospective controlled study involved 112 patients with laryngeal dysplasia treated over a 2-year period at a tertiary medical center. Patient data and clinical, stroboscopy, laryngomicroscopy, and histopathologic reports were reviewed. During the stroboscopy, glottic occlusion, phase symmetry, periodicity, amplitude, mucosal wave, and nonvibratory segments were followed. Laryngomicroscopy with different types of endoscopic cordectomies (types I-III) was performed as a therapeutic measure, with a 12-month follow-up period. Nonvibrating segments were present in 15.1% of the patients with mild dysplasia and in 38.5% of the patients with moderate dysplasia. In 45.5% of the patients with severe dysplasia (carcinoma in situ), nonvibrating segments were absent. The amplitude of vocal fold vibrations in patients with mild dysplasia (P ¼ 0.03) was a significant factor indicative of recurrent disease, but none of the stroboscopic signs was significant for the disease progression. Severe dysplasia can be related to both nonvibrating and vibrating vocal fold segments. Stroboscopy cannot be used reliably for classifying laryngeal dysplasia and may indicate the need to perform laryngomicroscopy with biopsy in suspicious vocal fold lesions. The warning factors for recurrence and progression of dysplasia are treatment modality, abnormal amplitude of vibration, and nonvibrating segment.
The causes of cholesteatoma development have been interpreted in different ways. The object of ou... more The causes of cholesteatoma development have been interpreted in different ways. The object of our study was to present the most frequent causes of recurring cholesteatomas on the basis of our investigations. The prospective study carried out at the Institute for Otorhinolaryngology and Maxillofacial Surgery included 120 patients treated surgically for cholesteatomas. Seventy-five patients were cured after the first operation, while 45 were reoperated after recurrent cholesteatoma. The modified student t test was used to establish the difference between statistically significant groups (small independent sample proportion). The cholesteatoma was often localized in attic (25.3%) and was spreading into antrum (28%). Another group of cholesteatoma was more frequently present in mesotympanum. The small marginal perforations in back quadrants were noted more frequently in the second group (26.7%). Likewise, 40% of the patients from this group had intact chain of auditory ossicles. Destruction of all three auditory ossicles was more often in the first group. Polypoid mucosa was less detected in the first group (18.7%) in relation to the second group (46.7%). Canal wall-up tympanoplasty was used more commonly in the second group of patients. In patients treated surgically for cholesteatoma, the recurrence of the condition may be caused by different factors such as development of cholesteatoma in posterior parts of cavum, polypoid mucosa, localization of cholesteatoma in meso-and retrotympanum and obscured cavity recesses, intact chain of auditory ossicles and the application of close tympanoplasty.
Endoscopic score was on average significantly lower after 6 and 12 months of FESS (p < 0.05), but... more Endoscopic score was on average significantly lower after 6 and 12 months of FESS (p < 0.05), but the mean score value after 12 months of operation was significantly higher in relation to that after 6 months of surgery (p < 0.05). nevertheless, the recurrence of nP was observed in 28 patients (32.9 %) in the follow-up period. In conclusion, FESS in nP patients results in significant improvement of symptom intensity, Qol and endoscopic score. While the intensity of symptoms and Qol showed a tendency to maintain between 6 and 12 months after surgery, endoscopic score showed a tendency of exacerbation in the same period.
Recent studies have evidenced that nasal polyposis (NP) may lead to significant limitations in ph... more Recent studies have evidenced that nasal polyposis (NP) may lead to significant limitations in physical, emotional and social aspects of life of the affected patients. The study is aimed to investigate the influence of asthma on quality of life (QoL), intensity of symptoms, endoscopic and computerized tomography (CT) sinus findings in patients with NP. The cross-sectional study included 88 adult patients with NP out of whom 35 (39.8 %) were asthmatic while 53 (60.2 %) were non-asthmatic. QoL is assessed based on Short Form-36 Health Survey (SF-36) questionnaire, while symptom intensity was presented using visual analogue scale (VAS). The objective finding is presented as endoscopic and CT score. Comparison of individual symptom intensity, total score and major symptom score failed to evidence any statistically significant difference between the groups. Minor symptom score which include intensity of headache, fetor ex ore, fatigue/ malaise, dental pain, cough, pressure/fullness in the ears and fever was higher in the group with asthma (p \ 0.05). Comparison of scores according to SF-36 domains, as well as summary scores for physical and mental health did not reveal statistically significant difference between the observed groups. Mean value of the endoscopic score in the group with asthma was 8.57 ± 2.22, being 8.38 ± 1.93 in the group without asthma (p [ 0.05). Mean value of the CT score in the groups with and without asthma was 20.37 ± 4.34 and 17.47 ± 4.75, respectively (p \ 0.01). Asthma has no influence on QoL and endoscopic findings of patients with NP, however it influences minor symptom score and CT findings.
, 85 patients with hypopharyngeal squamocellular carcinoma were admitted at the Department of Eso... more , 85 patients with hypopharyngeal squamocellular carcinoma were admitted at the Department of Esophagogastric Surgery in Belgrade. Among them, only 46 patients (54.1%) had radical surgical en-block resection and functional neck dissection, and they were included into an historical cohort study. In 40 patients a pharyngolaryngoesophagectomy was performed using for reconstruction, stomach tissue in 29 and colon tissue in 11 patients. Since 1996, in six patients with localized hypopharyngeal carcinoma pharyngolaryngectomy was performed with resection of cervical esophagus and free jejunal graft interposition. The overall incidence of morbidity was 50.0% and the overall mortality rate was 13.0% (6 patients). Mean hospital stay was 35 days (range, 18-78 days). The median survival of patients was 26 months, and overall 5-year survival rate was 26.5%. At present, surgery seems to be the appropriate therapeutic choice for patients with advanced hypopharyngeal carcinoma, providing a definitive palliation of dysphagia and relatively good long-term survival. At our Institution, after pharyngolaryngoesophagectomy, reconstructive method of choice is gastric 'pull-up', and the colon is used only when stomach tissue is not available, that is, previous gastric resections, inappropriate blood supply, synchronous gastric carcinoma and so on. Recently, pharyngolaryngectomy and free jejunal transfer has become the standard technique in patients with small carcinomas (up to 3 cm) confined to the hypopharynx in the absence of synchronous esophageal and/or gastric carcinoma.
Proposed methods for treating early glottic carcinoma are cordectomy through laryngofissure, lase... more 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. 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. 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. 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&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; surgeon and treatment preference, we consider endoscopic laser surgery highly efficient and preferred choice of treatment for early glottic carcinoma.
Injuries at work (occupational injuries) represent a big social and economic problem. This case r... more Injuries at work (occupational injuries) represent a big social and economic problem. This case report presents the patient who suffered occupational injury - open fracture of the left shin. He has been hospitalized for several times at Orthopedic-Surgical Hospital 'Banjica' and underwent several surgical procedures, physical therapy and Hyperbaric Oxygen Therapy. After this treatment, he was hospitalized at Institute of Occupational Health for disability evaluation and work capacity evaluation.
GI bleeding caused by Dieulafoy lesion in the gastric fundus: a case report Dieulafoy lesion is a... more GI bleeding caused by Dieulafoy lesion in the gastric fundus: a case report Dieulafoy lesion is a rare cause of massive gastrointestinal (GI) hemorrhage that can be fatal. It arises from an abnormally large eroded submucosal artery and in more than 75% of cases the lesion is mostly found within 6 cm of the cardia. The severity of bleeding and the site of the lesion render the diagnosis sometimes difficult, more than one endoscopic exam is often required. Surgery was regarded as the treatment of choice in the past, but recently endoscopic management has become the standard approach. We report a case of an 42-year-old man presented with upper GI hemorrhage. Repeated upper GI endoscopies revealed a missed diagnosis of subcardial gastric ulcer and Mallory-Weis lesion. Following conservative treatment, the frequency and amount of haemorrhage decreased and totally stop. 48 hours after admission patient developed sudden massive upper GI bleeding and underwent emergency total gastrectomy. T...
Introduction: Acute bleeding from the upper gastrointestinal tract remains the commonest emergenc... more Introduction: Acute bleeding from the upper gastrointestinal tract remains the commonest emergency in gastroenterology, and is most often caused by gastroduodenal ulcer disease. Despite introduction of novel endoscopic techniques and pharmacological treatment, 6-15% patients have to be operated. The aim of our investigation is analyze data of patients treated for gastrointestinal ulcer bleeding in our institution, their treatment options and outcome. Patients and methods: We included 2237 patients admitted in the Department for Emergency medicine of Clinical center of Serbia during the period from January 1999 until December 2003. because of gastroduodenal ulcer bleeding. We analyzed age, gender treatment option, hospital stay and mortality. Results: The mean age of our patients was 61.58 years, 1346 male and 891 female. The majority of patients were conservatively treated (84.5%). Operated patients mostly undergo Billroth II resection (57.8%). The mean hospital stay was 7.3 days. A...
Hemorrhagic shock is a condition produced by rapid and significant loss of blood which lead to he... more Hemorrhagic shock is a condition produced by rapid and significant loss of blood which lead to hemodynamic instability, decreases in oxygen delivery, decreased tissue perfusion, cellular hypoxia, organ damage and can be rapidly fatal. Despite improved understanding of the pathophysiology and significant advances in technology, it remains a serious problem associated with high morbidity and mortality. Early treatment is essential but is hampered by the fact that signs and symptoms of shock appear only after the state of shock is well establish and the compensatory mechanisms have started to fail. The primary goal is to stop the bleeding and restore the intravascular volume. This review addresses the pathophysiology and treatment of hemorrhagic shock.
Congenital pseudoarthrosis (CPT) of the lower leg is still a considerable therapeutic problem. Th... more Congenital pseudoarthrosis (CPT) of the lower leg is still a considerable therapeutic problem. There are many surgical and other procedures to manage pseudoarthrosis, but the results are not always satisfactory, unfortunately, and are accompanied by a big number of complications, even limb amputation in some cases. The most complicated surgical procedure is transplantation of the autogenous free microvascular fibula coil which has had the best results momentarily. We are showing a case of a 2.5- year old patient with congenital pseudoarthrosis of the lower leg previously treated unsuccessfully by a conventional surgical method. This is at the same time the first case of such operative treatment of CPT in the territory of Serbia and Montenegro as well as former Yugoslavia. The patient was operated in October 1992.
The ankle fractures continue to be a topical issue in orthopedic surgery. X-ray diagnostics, but ... more The ankle fractures continue to be a topical issue in orthopedic surgery. X-ray diagnostics, but primarily also other modern diagnostic procedures such as CT, MRI, and arthroscopy enable detection of not only fractures but also osteocartilaginous fractures and soft-tissue ligamentary lesions, which are frequent causes of pain and instability of the ankle. The key segment is the posterio-lateral segment and tibio-fibular syndesmosis whose integrity is sometimes only surgically establishable. In the ankle treatment, stable fixation - since recently by means of resorptive osteofixation materials - and early rehabilitation of the operated ankle are aimed at. The open and pylon fractures, as the most severe forms of ankle fractures, are treated by external fixation with minimum internal fixation (hybrid fixation) of the ankle with conversion of the rigid into a dynamic (articulated) external fixator enabling movement and nutrition of the damaged articular cartilage.
The article describes injuries of soft and bone structures of the shoulder region, with special e... more The article describes injuries of soft and bone structures of the shoulder region, with special emphasis on the following clinical forms: instabilities and luxations of the glenohumeral joint, fractures of the proximal humerus, clavicle and the states of painful shoulder. Fractures and dislocations, but also significant entities - painful states caused not only by fractures but also by minor trauma such as tendinitises and m.supraspinatus tendon and bicipital tendon ruptures are discussed in more detail. Moreover, their consequences - painful and stiff shoulder - as well as modern diagnostic and therapeutic procedures applied in the painful shoulder treatment are also discussed.
In July 1999, the European Laryngological Society (ELS) has accepted a proposal for the classiWca... more In July 1999, the European Laryngological Society (ELS) has accepted a proposal for the classiWcation of diVerent laryngeal endoscopic cordectomies. This is actually a common classiWcation system used as a tool for surgical training, documentation and comparison of results. The same harmonization work is deemed necessary for the treatment of supraglottic lesions. The ELS is proposing a classiWcation of the diVerent laryngeal endoscopic supraglottic partial laryngectomies. This classiWcation comprises four types of supraglottic laryngectomies: Type I, limited excision of small size superWcial lesions of the free edge of the epiglottis, the ary-epiglottic fold, the arytenoid, or the ventricular fold or any other part of the supraglottis; Type II, medial supraglottic laryngectomy without resection of the preepiglottic space, suitable for T1 lesions of either the suprahyoid or the infrahyoid laryngeal surface of the epiglottis (Type IIa, superior hemi-epiglottectomy or Type IIb, total epiglottectomy, respectively); Type III, medial supraglottic laryngectomy with resection of the pre-epiglottic space, suitable for T1-T2 tumors of the infrahyoid endolaryngeal epiglottis without (Type IIIa) or with (Type IIIb) extension to the ventricular fold, necessitating its excision; Wnally, Type IV, lateral
Korisnost radikalne disekcije nikada se ne bi dovodila u pitanje ako bi njena efikasnost bila sav... more Korisnost radikalne disekcije nikada se ne bi dovodila u pitanje ako bi njena efikasnost bila savr-{ena. Medjutim postoje onkolo{ki nedostatci pa kada im se doda postoperativni morbiditet, koji se ogleda u funkcionalnim poreme}ajima i kozmetskim nedostatcima, opravdano je tra'enje novih terapijskih pristupa. Istra'ivanjem je obuhva}eno 319 bolesnika koji su operisani u periodu od 1. januara 2000. do 31.decembra 2002. godine i konzilijarno pra}eni 5 godina od operativnog zahvata. Cilj na{eg istra'ivanja je da utvrdimo distribuciju operativnih povreda akcesorijusa kod modifikovane radikalne disekcije i odnos bolnog i spu{tenog ramena kod modifikovane radikalne i radikalne disekcije vrata. U~estalost ispitanika sa o{te}enim akcesorijusom je visoko zna~ajno redja posle modifikovane radikalne disekcije nego posle radikalne disekcije. U~estalost ispitanika se visoko zna~ajno razlikuje (χm 2 = 26.662; df = 1; p<0.01) po kategorijama komplikacija akcesorijusa (bo-lno rame, spu{teno rame) i vrstama disekcija (MRDV, RDV). Visoko zna~ajno je manje sa komplikacijama (bolno rame, spu{teno rame) posle modifikovane radikalne disekcije vrata (p<0.01). Klju~ne re~i: modifikovana radikalna disekcija vrata, n.accesorius, bolno rame UVOD K orisnost radikalne disekcije nikada se ne bi dovodila u pitanje ako bi njena efikasnost bila savr{ena. Medjutim postoje onkolo{ki nedostatci pa kada im se doda postoperativni morbiditet, koji se ogleda u funkcionalnim poreme}ajima i kozmetskim nedostatcima, opravdano je tra'enje novih terapijskih pristupa. Prve komplikacije radikalne disekcije vrata u smislu sindroma bolnog ramena zabele'ene su jo{ 1952. godine od strane Ewinga 1 i saradnika.
Background: The Voice Handicap Index-10 (VHI-10) is used in clinics because of its validity and e... more Background: The Voice Handicap Index-10 (VHI-10) is used in clinics because of its validity and ease of use by patients. Objectives: The aim of this paper was to evaluate the internal consistency, reliability, and clinical validity of the Serbian version of the VHI-10. Method: In this cross-sectional study, we translated the original English version of the VHI-10 into Serbian, after which it was back-translated into English. The Serbian version of the VHI-10 was completed by 161 patients with voice disorders, divided into 4 groups according disease etiology (structural, neurological, functional, and inflammatory) and 73 healthy control subjects. Results: The VHI-10 internal consistency was 0.88. Spearman’s rank correlation coefficient for VHI-10 test-retest reliability was ρ = 0.991 (p< 0.001). Patients with voice disorders had higher median total VHI-10 scores compared with controls (p< 0.001). The patients’ Grade, Instability, Roughness, Breathiness, Asthenia, and Strain (GI...
Malignant tumors of the oral cavity grow rapidly, frequently and early metastazing to the surroun... more Malignant tumors of the oral cavity grow rapidly, frequently and early metastazing to the surrounding regional lymph nodes. The aim of this study was to evaluate the correlation between clinically confirmed local and regional spread and intraoperatively and histopathologically verified local spread. A series of 74 patients with carcinoma of the tongue and floor of the mouth were analyzed. All the patients were surgically treated during the period 1991-1995. Clinical evidence of local spread (cT) was in high accord with intraoperatively and histopathologically evidenced spread (pT) amounting to 83.8%. The degree of correlation decreased with the increase of T stage. Clinically observed regional spread (cN) and intraoperatively and histopathologically confirmed regional spread (pN) was lower, amounting to 56.8% in comparison to the corresponding T categories.
Background/Aim. Chronic sinusitis is a disease characterized with mucosal inflammatoion of nasal ... more Background/Aim. Chronic sinusitis is a disease characterized with mucosal inflammatoion of nasal and paranasal sinuses for at least 12 weeks. In order to assess the extent and severity of inflammatory changes in paranasal sinuses CT score according to Lund-Mackay is the most commonly used. Recent studies show the possibility of existing different subtipes of chronic rhinosinusitis, pointing out the presence of nasal polyps and their influence on the severity of chronic rhinosinusitis. The aim of this research was to examine the influence of sinonasal polyposis on the extensity of inflammatory changes on computerized tomography (CT), evaluated by the Lund-Mackay CT score. Methods. A prospective study compared the Lund-Mackay CT score values between the patients with chronic rhinosinusitis associated with nasal polyps and those without them. We determined mean values of the total CT score in both groups of the patients, as well as mean values of CT score for each group of sinuses and ...
Please cite this article in press as: Banko B, et al. MRI in evaluation of neoplastic invasion in... more Please cite this article in press as: Banko B, et al. MRI in evaluation of neoplastic invasion into preepiglottic and paraglottic space. Auris Nasus Larynx (2014),
Vocal fold pathology changes the appearance and vibratory patterns observed during stroboscopic e... more Vocal fold pathology changes the appearance and vibratory patterns observed during stroboscopic examination, but a strict correlation between the vibratory pattern and the dysplasia type does not exist. The aims of this study were to determine the role of stroboscopy in vocal fold dysplasia assessment and to determine whether stroboscopy is the deciding factor when performing laryngomicroscopy with biopsy in suspicious lesions. This prospective controlled study involved 112 patients with laryngeal dysplasia treated over a 2-year period at a tertiary medical center. Patient data and clinical, stroboscopy, laryngomicroscopy, and histopathologic reports were reviewed. During the stroboscopy, glottic occlusion, phase symmetry, periodicity, amplitude, mucosal wave, and nonvibratory segments were followed. Laryngomicroscopy with different types of endoscopic cordectomies (types I-III) was performed as a therapeutic measure, with a 12-month follow-up period. Nonvibrating segments were present in 15.1% of the patients with mild dysplasia and in 38.5% of the patients with moderate dysplasia. In 45.5% of the patients with severe dysplasia (carcinoma in situ), nonvibrating segments were absent. The amplitude of vocal fold vibrations in patients with mild dysplasia (P ¼ 0.03) was a significant factor indicative of recurrent disease, but none of the stroboscopic signs was significant for the disease progression. Severe dysplasia can be related to both nonvibrating and vibrating vocal fold segments. Stroboscopy cannot be used reliably for classifying laryngeal dysplasia and may indicate the need to perform laryngomicroscopy with biopsy in suspicious vocal fold lesions. The warning factors for recurrence and progression of dysplasia are treatment modality, abnormal amplitude of vibration, and nonvibrating segment.
The causes of cholesteatoma development have been interpreted in different ways. The object of ou... more The causes of cholesteatoma development have been interpreted in different ways. The object of our study was to present the most frequent causes of recurring cholesteatomas on the basis of our investigations. The prospective study carried out at the Institute for Otorhinolaryngology and Maxillofacial Surgery included 120 patients treated surgically for cholesteatomas. Seventy-five patients were cured after the first operation, while 45 were reoperated after recurrent cholesteatoma. The modified student t test was used to establish the difference between statistically significant groups (small independent sample proportion). The cholesteatoma was often localized in attic (25.3%) and was spreading into antrum (28%). Another group of cholesteatoma was more frequently present in mesotympanum. The small marginal perforations in back quadrants were noted more frequently in the second group (26.7%). Likewise, 40% of the patients from this group had intact chain of auditory ossicles. Destruction of all three auditory ossicles was more often in the first group. Polypoid mucosa was less detected in the first group (18.7%) in relation to the second group (46.7%). Canal wall-up tympanoplasty was used more commonly in the second group of patients. In patients treated surgically for cholesteatoma, the recurrence of the condition may be caused by different factors such as development of cholesteatoma in posterior parts of cavum, polypoid mucosa, localization of cholesteatoma in meso-and retrotympanum and obscured cavity recesses, intact chain of auditory ossicles and the application of close tympanoplasty.
Endoscopic score was on average significantly lower after 6 and 12 months of FESS (p < 0.05), but... more Endoscopic score was on average significantly lower after 6 and 12 months of FESS (p < 0.05), but the mean score value after 12 months of operation was significantly higher in relation to that after 6 months of surgery (p < 0.05). nevertheless, the recurrence of nP was observed in 28 patients (32.9 %) in the follow-up period. In conclusion, FESS in nP patients results in significant improvement of symptom intensity, Qol and endoscopic score. While the intensity of symptoms and Qol showed a tendency to maintain between 6 and 12 months after surgery, endoscopic score showed a tendency of exacerbation in the same period.
Recent studies have evidenced that nasal polyposis (NP) may lead to significant limitations in ph... more Recent studies have evidenced that nasal polyposis (NP) may lead to significant limitations in physical, emotional and social aspects of life of the affected patients. The study is aimed to investigate the influence of asthma on quality of life (QoL), intensity of symptoms, endoscopic and computerized tomography (CT) sinus findings in patients with NP. The cross-sectional study included 88 adult patients with NP out of whom 35 (39.8 %) were asthmatic while 53 (60.2 %) were non-asthmatic. QoL is assessed based on Short Form-36 Health Survey (SF-36) questionnaire, while symptom intensity was presented using visual analogue scale (VAS). The objective finding is presented as endoscopic and CT score. Comparison of individual symptom intensity, total score and major symptom score failed to evidence any statistically significant difference between the groups. Minor symptom score which include intensity of headache, fetor ex ore, fatigue/ malaise, dental pain, cough, pressure/fullness in the ears and fever was higher in the group with asthma (p \ 0.05). Comparison of scores according to SF-36 domains, as well as summary scores for physical and mental health did not reveal statistically significant difference between the observed groups. Mean value of the endoscopic score in the group with asthma was 8.57 ± 2.22, being 8.38 ± 1.93 in the group without asthma (p [ 0.05). Mean value of the CT score in the groups with and without asthma was 20.37 ± 4.34 and 17.47 ± 4.75, respectively (p \ 0.01). Asthma has no influence on QoL and endoscopic findings of patients with NP, however it influences minor symptom score and CT findings.
, 85 patients with hypopharyngeal squamocellular carcinoma were admitted at the Department of Eso... more , 85 patients with hypopharyngeal squamocellular carcinoma were admitted at the Department of Esophagogastric Surgery in Belgrade. Among them, only 46 patients (54.1%) had radical surgical en-block resection and functional neck dissection, and they were included into an historical cohort study. In 40 patients a pharyngolaryngoesophagectomy was performed using for reconstruction, stomach tissue in 29 and colon tissue in 11 patients. Since 1996, in six patients with localized hypopharyngeal carcinoma pharyngolaryngectomy was performed with resection of cervical esophagus and free jejunal graft interposition. The overall incidence of morbidity was 50.0% and the overall mortality rate was 13.0% (6 patients). Mean hospital stay was 35 days (range, 18-78 days). The median survival of patients was 26 months, and overall 5-year survival rate was 26.5%. At present, surgery seems to be the appropriate therapeutic choice for patients with advanced hypopharyngeal carcinoma, providing a definitive palliation of dysphagia and relatively good long-term survival. At our Institution, after pharyngolaryngoesophagectomy, reconstructive method of choice is gastric 'pull-up', and the colon is used only when stomach tissue is not available, that is, previous gastric resections, inappropriate blood supply, synchronous gastric carcinoma and so on. Recently, pharyngolaryngectomy and free jejunal transfer has become the standard technique in patients with small carcinomas (up to 3 cm) confined to the hypopharynx in the absence of synchronous esophageal and/or gastric carcinoma.
Proposed methods for treating early glottic carcinoma are cordectomy through laryngofissure, lase... more 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. 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. 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. 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&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; surgeon and treatment preference, we consider endoscopic laser surgery highly efficient and preferred choice of treatment for early glottic carcinoma.
Injuries at work (occupational injuries) represent a big social and economic problem. This case r... more Injuries at work (occupational injuries) represent a big social and economic problem. This case report presents the patient who suffered occupational injury - open fracture of the left shin. He has been hospitalized for several times at Orthopedic-Surgical Hospital 'Banjica' and underwent several surgical procedures, physical therapy and Hyperbaric Oxygen Therapy. After this treatment, he was hospitalized at Institute of Occupational Health for disability evaluation and work capacity evaluation.
GI bleeding caused by Dieulafoy lesion in the gastric fundus: a case report Dieulafoy lesion is a... more GI bleeding caused by Dieulafoy lesion in the gastric fundus: a case report Dieulafoy lesion is a rare cause of massive gastrointestinal (GI) hemorrhage that can be fatal. It arises from an abnormally large eroded submucosal artery and in more than 75% of cases the lesion is mostly found within 6 cm of the cardia. The severity of bleeding and the site of the lesion render the diagnosis sometimes difficult, more than one endoscopic exam is often required. Surgery was regarded as the treatment of choice in the past, but recently endoscopic management has become the standard approach. We report a case of an 42-year-old man presented with upper GI hemorrhage. Repeated upper GI endoscopies revealed a missed diagnosis of subcardial gastric ulcer and Mallory-Weis lesion. Following conservative treatment, the frequency and amount of haemorrhage decreased and totally stop. 48 hours after admission patient developed sudden massive upper GI bleeding and underwent emergency total gastrectomy. T...
Introduction: Acute bleeding from the upper gastrointestinal tract remains the commonest emergenc... more Introduction: Acute bleeding from the upper gastrointestinal tract remains the commonest emergency in gastroenterology, and is most often caused by gastroduodenal ulcer disease. Despite introduction of novel endoscopic techniques and pharmacological treatment, 6-15% patients have to be operated. The aim of our investigation is analyze data of patients treated for gastrointestinal ulcer bleeding in our institution, their treatment options and outcome. Patients and methods: We included 2237 patients admitted in the Department for Emergency medicine of Clinical center of Serbia during the period from January 1999 until December 2003. because of gastroduodenal ulcer bleeding. We analyzed age, gender treatment option, hospital stay and mortality. Results: The mean age of our patients was 61.58 years, 1346 male and 891 female. The majority of patients were conservatively treated (84.5%). Operated patients mostly undergo Billroth II resection (57.8%). The mean hospital stay was 7.3 days. A...
Hemorrhagic shock is a condition produced by rapid and significant loss of blood which lead to he... more Hemorrhagic shock is a condition produced by rapid and significant loss of blood which lead to hemodynamic instability, decreases in oxygen delivery, decreased tissue perfusion, cellular hypoxia, organ damage and can be rapidly fatal. Despite improved understanding of the pathophysiology and significant advances in technology, it remains a serious problem associated with high morbidity and mortality. Early treatment is essential but is hampered by the fact that signs and symptoms of shock appear only after the state of shock is well establish and the compensatory mechanisms have started to fail. The primary goal is to stop the bleeding and restore the intravascular volume. This review addresses the pathophysiology and treatment of hemorrhagic shock.
Congenital pseudoarthrosis (CPT) of the lower leg is still a considerable therapeutic problem. Th... more Congenital pseudoarthrosis (CPT) of the lower leg is still a considerable therapeutic problem. There are many surgical and other procedures to manage pseudoarthrosis, but the results are not always satisfactory, unfortunately, and are accompanied by a big number of complications, even limb amputation in some cases. The most complicated surgical procedure is transplantation of the autogenous free microvascular fibula coil which has had the best results momentarily. We are showing a case of a 2.5- year old patient with congenital pseudoarthrosis of the lower leg previously treated unsuccessfully by a conventional surgical method. This is at the same time the first case of such operative treatment of CPT in the territory of Serbia and Montenegro as well as former Yugoslavia. The patient was operated in October 1992.
The ankle fractures continue to be a topical issue in orthopedic surgery. X-ray diagnostics, but ... more The ankle fractures continue to be a topical issue in orthopedic surgery. X-ray diagnostics, but primarily also other modern diagnostic procedures such as CT, MRI, and arthroscopy enable detection of not only fractures but also osteocartilaginous fractures and soft-tissue ligamentary lesions, which are frequent causes of pain and instability of the ankle. The key segment is the posterio-lateral segment and tibio-fibular syndesmosis whose integrity is sometimes only surgically establishable. In the ankle treatment, stable fixation - since recently by means of resorptive osteofixation materials - and early rehabilitation of the operated ankle are aimed at. The open and pylon fractures, as the most severe forms of ankle fractures, are treated by external fixation with minimum internal fixation (hybrid fixation) of the ankle with conversion of the rigid into a dynamic (articulated) external fixator enabling movement and nutrition of the damaged articular cartilage.
The article describes injuries of soft and bone structures of the shoulder region, with special e... more The article describes injuries of soft and bone structures of the shoulder region, with special emphasis on the following clinical forms: instabilities and luxations of the glenohumeral joint, fractures of the proximal humerus, clavicle and the states of painful shoulder. Fractures and dislocations, but also significant entities - painful states caused not only by fractures but also by minor trauma such as tendinitises and m.supraspinatus tendon and bicipital tendon ruptures are discussed in more detail. Moreover, their consequences - painful and stiff shoulder - as well as modern diagnostic and therapeutic procedures applied in the painful shoulder treatment are also discussed.
In July 1999, the European Laryngological Society (ELS) has accepted a proposal for the classiWca... more In July 1999, the European Laryngological Society (ELS) has accepted a proposal for the classiWcation of diVerent laryngeal endoscopic cordectomies. This is actually a common classiWcation system used as a tool for surgical training, documentation and comparison of results. The same harmonization work is deemed necessary for the treatment of supraglottic lesions. The ELS is proposing a classiWcation of the diVerent laryngeal endoscopic supraglottic partial laryngectomies. This classiWcation comprises four types of supraglottic laryngectomies: Type I, limited excision of small size superWcial lesions of the free edge of the epiglottis, the ary-epiglottic fold, the arytenoid, or the ventricular fold or any other part of the supraglottis; Type II, medial supraglottic laryngectomy without resection of the preepiglottic space, suitable for T1 lesions of either the suprahyoid or the infrahyoid laryngeal surface of the epiglottis (Type IIa, superior hemi-epiglottectomy or Type IIb, total epiglottectomy, respectively); Type III, medial supraglottic laryngectomy with resection of the pre-epiglottic space, suitable for T1-T2 tumors of the infrahyoid endolaryngeal epiglottis without (Type IIIa) or with (Type IIIb) extension to the ventricular fold, necessitating its excision; Wnally, Type IV, lateral
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