Chordoma of the Oropharynx.

Background: Chordoma is a rare malignant neoplasm that predominantly arises from the axial skeleton, but can also develop in unusual locations. However, there are also rare cases of "NOS" chordoma involving the oropharyx and epithelial-myoepithelial carcinoma of the parotid gland in the same patient. According to contemporary research, chordoma is a rare malignant neoplasm that arises from the embryonic remnants of the notochord. and typically involves the clivus, sacrococcygeal bones or vertebrae. Studies have shown that the incidence of chordoma has been estimated to be one per one million people per year. Chordoma can occur at any age, but most commonly it is diagnosed in the 40-60 year old age group with the male predominance. Objective: The aim of this article was to review the case of a 74-year-old female patient with epithelial-myoepithelial carcinoma of the parotid gland and a case of "NOS" chordoma involving the oropharyx. Methods: Diagnostic methods were used to examine a female patient with two primary malignant tumors: CT neck scan, CT of paranasal sinuses, ultrasound examination, scintigraphy and operative finding. Case presentzation: Due to the anatomy complexity, complete resection of the tumor through a transoral-transpharyngeal approach was not possible. Intraoperative palpation of the mass revealed well defined submucosal lesion 20x43x46mm beginning at the level of the oro- and hypopharynx and extending superiorly to the nasopharynx, and posteriorly into the spinal canal and intervertebral foramen causing near complete occlusion of the oro and hypopharynx. The patient also underwent extracapsular dissection of the parotid tumor. Postoperative palliative radiotherapy was performed. Conclusion: Surgical treatment remains the mainstay of treatment for EMC and radiation is imperative for patients who refuse surgery and for those with advanced or inoperable diseases.

Correlation of localization and size of the parathyroid glands by ultrasound and intraoperative findings in hyperparathyroidism.

Aim To determine a correlation between the localization of the parathyroid gland (PTG), based on ultrasound (US) examination and the operative findings, as well as the correlation between the size of the parathyroid glands measured by ultrasonography (USG) with pathological findings+, and prevalence of enlarged parathyroid glands in various forms of hyperparathyroidism. Methods A total of 83 patients with hyperparathyroidism who had undergone parathyroidectomy over a period of seven years were included in the study. US examinations of the neck and scintigraphy were performed before surgery in 83 and 42 patients, respectively. In the pathohistological analysis, in addition to diagnosis, the size and weight of the parathyroid gland were measured. Results US examination revealed 125 enlarged parathyroid glands and two normal-sized glands. Scintigraphy revealed 52 enlarged and three normal-sized parathyroid glands. Enlarged parathyroid glands were more frequently found in the projection of the lower pole thyroid glands. A significantly higher number of enlarged upper parathyroid glands were found by the operative findings than by US. There was no statistically significant difference in the diagnosis of enlarged parathyroid glands in all three forms of hyperparathyroidism. There was a positive correlation between the size of the parathyroid glands obtained by US and the size of the operative finding (κ=0.51; p=0.00 and p<0.0005, respectively). The relationship between parathyroid gland size measured by ultrasound and pathological analysis showed a positive correlation. Conclusion Ultrasound was useful in evaluating enlarged parathyroid glands, especially in combination with scintigraphy.

Hyperparathyroidism: Pathological Diagnosis and Association with Parathyroid Localization.

Background: The most comon patohistological finding in primary hyperparathyroidism is adenoma of the parathyroid gland, followed by hyperplasia and the rarest is carcinoma. However, hyperplasia of the parathyroid glands (PTG) is most commonly found in secondary and tertiary hyperparathyroidism. Objective: To determine the relationship between the localization of the parathyroid glands and pathological diagnosis, as well as the prevalence of individual pathological diagnosis after surgery in patients with hyperparathyroidism. Methods: Analysis of retrospective-prospective database of 79 patiens who underwent parathyreoidectomy for hyperparathyroidism in the 7-year study period. Diagnostic methods were used to identify enlarged parathyroid glands as well as to determine their localization: ultrasound examination, scintigraphy and operative finding. Standard hematoxylin eosin staining was used for pathohistological diagnosis. A correlation analysis between parathyroid gland localization and pathohistological diagnosis was performed. Results: The median age of the patients were 51 age (range 20-73) and 67,1% of the patients were female. In the total number of surgically removed parathyroid glands (182), the most common pathohistological diagnosis was hyperplasia. Parathyroid adenoma was found in 21 cases. Other diagnoses (thyroid nodule / tissue, lymph node, thymus, cancer) were found in 11 cases, while a normal finding was found in 12 glands. Pathohistological diagnosis of hyperplasia and adenoma were more common in the lower parathyroid glands. Using the chi-square test, no association was found between pathohistological diagnosis and localization of enlarged parathyroid glands. Conclusion: The most common pathohistological diagnosis in hyperparathyroidism was hyperplasia and was most commonly found in the inferior parathyroid glands. Adenoma as pathohistological diagnosis is also most commonly found in the lower parathyroid glands, but without statistical significance.

Correlation of subglottic laryngitis in children and meteorological parameters.

Considering hospitalization as an indicator of the severity of acute subglottic laryngitis (ASL), the aim of this study was to determine the correlation between meteorological parameters and the incidence of ASL in children from the Tuzla area. The study included fifty-nine boys and girls from the Tuzla area, which were referred and hospitalized due to the ASL at the Clinic for diseases of ear, nose, throat, cervical and maxillofacial Surgery, University Clinical Center in Tuzla, Bosnia and Herzegovina, during the period of March 21st 2006 until March 20th 2007. We formed two databases: 1. the database on each hospitalized child included data on Body Mass Index (BMI), sex and age. 2. Meteorology database which included information on humidity, air temperature, wind direction and atmospheric pressure, sorted by day, month and season. The results of this study indicate that the number of hospitalized boys due to ASL was significantly higher than girls (48 boys and 11 girls). Boys with an average BMI of 34.53 kg/m2 and 6.77 years of age suffered more frequently from the ASL (81.35%) than girls (18.64%) with an average BMI of 21.59 kg/m2 and the age of 3.8 years. The largest number of children with ASL was admitted during the period of lowest temperature (Fall-12.27 degrees C; Winter-0.50 degrees C), and the largest value of relative humidity (fall 77.33 mmHg-winter 82.50 mmHg). Therefore, this study indicates that meteorological factors (temperature, humidity, wind direction, atmospheric pressure) increase the risk of ASL with young children, primarily boys.

Pattern of head and neck malignant tumours in a Tuzla ENT clinic--a five year experience.

Head and neck neoplasia can affect certain fundamental functions, including eating, drinking, speaking and respiration. One overriding factor in deciding on treatment policy is the tendency for head and neck malignancy to be limited to the primary site and regional lymph nodes with surgery and chemotherapy and radiotherapy. The aim of the study was to analyze the occurrence of Head and Neck tumours operated at ENT clinic Tuzla, University Clinical Center Tuzla, Bosnia and Herzegovina. Medical records of patients with histopathologically confirmed head and neck malignancies over a 5 year period (2003-2007) were analyzed. Eight hundred and eight one (881) cases, made up of 519 (58,8%) males and 362 (41,1%) females were found. The most common sites for head and neck malignancies were found to be in the larynx (26,1%), oral cavity (21,7%), the thyroid gland (14,64 %) and the neck (8,51%). A total of 230 patients were diagnosed with laryngeal carcinoma (M:173; F:57), showing the increasing number of female patients. The histopathological tumour types found in this work were mostly squamous cell carcinoma (72,09%), papillary carcinoma (12,2%), while many other minor histopathological variants accounted for 13%. The most patients were presented with stage I and stage III of disease (27% and 28,3%), and 19,9% with stage IV. About 40% of patients did not have data about smoking habit and alcohol drinking. The incidence of head and neck tumours seems to be relatively high, but without significant increase during investigated period. More investigation concerning risk factors, diagnostic procedures, and management strategies should be done in future.

[BMI of the children attending elementary schools in Tuzla Canton]. / BMI kod djece osnovnoskolskog uzrasta na podrucju tuzlanskog kantona.

BMI is frequently used in different studies as indicator of nutritional status. When BMI exceeds the limit values then it represents the risk factor leading to different diseases; therefore it is important to calculate BMI for young persons. In cases when BMI differs from the recommended value it is necessary to apply different measures in order to prevent diseases. The aim of this paper was to assess the present status and on the basis of the result obtained to assess the need for eventual preventive activities leading to healthy life stytes. This study was performed on a sample of 1544 school boys and girls aged eight, ten and fourteen attending first, third and seventh class of elementary school. The study covered four municipalities of Tuzla Canton: Tuzla, Lukavac, Gradanica and Kladanj, and both urban and rural areas. We used the method of anthropometric measurement (IBP International Biological Program) of body mass and body height, followed by calculation of BMI and statistical evaluation. This study found that the average BMI of girls and boys is increasinglongitudinally with the age, with significant change between 10 years and 14 years, without significant gen der difference. Boys aged eight have BMI 15.76, len years 16.52 and are similar to the BMI of girls aged eight 15.44 and ten years 16.59. Fourteen-year-old girls have BMI which is 19.54, higher than the BMI of boys at the same age which is 18.75. Having in mind the range of BMI percentile values for normal nutritional status (from 5 to 85) the values for eight years old boys ranged from 14.1 to 19.4, for ten-year-old boys from 13.4 to 19.2, and for fourteen-year-old boys from 13.6 to 19.5. The values for girls showed the following results; for eight-year-old girls the value ranged from 13.9 to 20.6; for ten-year-old girls t'rom 13.5 to 20.5 and fourteen-year-old girls from 13.7 to 19.6. In the sample there was 6.6% underweight children, and 15.2% overweight children, but the portion of overweight individuals is bigger in the sample of fourteen-year-old children. This fact leads to the need for permanent education of the overall population, focusing on children and youth and healthy life styles highlighting correction of diet.