Laryngopharyngeal Reflux Scoring in a Pediatric Population.

In recent years, the prevalence of laryngopharyngeal reflux has risen, especially among pediatric patients. The diagnosis of laryngopharyngeal reflux relies on patient history and clinical assessment using the Reflux Finding Score and Reflux Symptom Index as crucial diagnostic tools. Some studies have proposed a link between pepsin and laryngopharyngeal reflux, potentially triggering palatine tonsil hypertrophy. Our study aimed to investigate the correlation between laryngeal and pharyngeal manifestations of laryngopharyngeal reflux through two questionnaires and the presence of pepsin in saliva and palatine tonsils in a pediatric population. Pepsin in saliva was detected using a Western blot method, while immunohistochemistry assessed its presence in palatine tonsils. Although no statistically significant differences in Reflux Finding Score and Reflux Symptom Index were found between the immunohistochemistry-positive (IHC-positive) and immunohistochemistry-negative (IHC-negative) groups, median reflux symptom index and Reflux Finding Score values consistently trended higher in the IHC-positive group. This suggests a potential connection between elevated index values and pepsin presence in tonsillar tissue. Further investigations are essential to fully comprehend the clinical implications of these findings.

Pretreatment hearing grades and hearing recovery outcomes after primary hyperbaric oxygen treatment in patients with idiopathic sudden sensorineural hearing loss.

INTRODUCTION: Previous studies suggest the effectiveness of hyperbaric oxygen treatment (HBOT) in idiopathic sudden sensorineural hearing loss (ISSNHL) but it is mostly used as an adjuvant and salvage treatment. This study evaluated the effect of primary HBOT according to pretreatment hearing grades and hearing recovery outcomes using modified Siegel's criteria in patients with ISSNHL. METHODS: Fifty-nine ISSNHL patients treated with only HBOT were included. A pure-tone audiogram was recorded before and after a course of HBOT (90 min at 203 kPa daily for 20 days). Using the modified Siegel's criteria, patients were divided into groups according to hearing threshold before and after treatment. RESULTS: Hearing thresholds were significantly lower after HBOT compared to pre-treatment values across all patients (P < 0.001) with a median value of recovery of 22.5 dB (interquartile range 12.5-33.7 dB). Significantly lower hearing threshold values were recorded at 500, 1,000, 2,000, and 4,000 Hz after treatment (P < 0.001). The greatest recovery was at 1,000 Hz, (change in median threshold = 32 dB) but without a significant difference compared to other frequencies (P = 0.10). CONCLUSIONS: HBOT is a legitimate choice as the primary treatment for ISSNHL, especially if it is readily accessible, and if there are contraindications for corticosteroid therapy.

Expression of Oxidative Stress and Inflammation-Related Genes in Nasal Mucosa and Nasal Polyps from Patients with Chronic Rhinosinusitis.

Chronic rhinosinusitis (CRS) is a prevalent, multifaceted inflammatory condition affecting the nasal cavity and the paranasal sinuses, frequently accompanied by formation of nasal polyps (CRSwNP). This apparently uniform clinical entity is preceded by heterogeneous changes in cellular and molecular patterns, suggesting the presence of multiple CRS endotypes and a diverse etiology. Alterations of the upper airway innate defense mechanisms, including antimicrobial and antioxidant capacity, have been implicated in CRSwNP etiology. The aim of this study was to investigate mRNA expression patterns of antioxidative enzymes, including superoxide dismutase (SOD) and peroxiredoxin-2 (PRDX2), and innate immune system defense players, namely the bactericidal/permeability-increasing fold-containing family A, member 1 (BPIFA1) and PACAP family members, particularly adenylate-cyclase-activating polypeptide receptor 1 (ADCYAP1) in nasal mucosa and nasal polyps from CRSwNP patients. Additional stratification based on age, sex, allergic comorbidity, and disease severity was applied. The results showed that ADCYAP1, BPIFA1, and PRDX2 transcripts are differentially expressed in nasal mucosa and scale with radiologically assessed disease severity in CRSwNP patients. Sinonasal transcriptome is not associated with age, sex, and smoking in CRSwNP. Surgical and postoperative corticosteroid (CS) therapy improves endoscopic appearance of the mucosa, but variably reverses target gene expression patterns in the nasal cavity of CRSwNP patients. Transcriptional cross-correlations analysis revealed an increased level of connectedness among differentially expressed genes under inflammatory conditions and restoration of basic network following CS treatment. Although results of the present study imply a possible engagement of ADCYAP1 and BPIFA1 as biomarkers for CRSwNP, a more profound study taking into account disease severity and CRSwNP endotypes prior to the treatment would provide additional information on their sensitivity.

RELATIONSHIP BETWEEN BODY MASS INDEX AND PATOHISTOLOGICAL FEATURES OF THYROID CANCER.

Available studies report conflicting results on the association of body mass index (BMI) and pathohistological features of thyroid cancer. This study aimed to investigate the relationship between BMI and the pathohistological features of different thyroid cancer types. We analyzed the following data from 95 patients with thyroid cancer: age, gender, BMI, pathohistological characteristics of cancer (tumor size, multifocality, lymphovascular invasion, extrathyroidal invasion) and the presence of regional metastases. The BMI of all patients with thyroid cancer was 27.1 ± 4.2. Significantly more patients with obesity class I had cancer size less than 2 cm (p = 0.02). There is a significant association between BMI and extrathyroid invasion (p = 0.03; OR, 1.18), but not with lymphovascular invasion, tumor size, and multifocality. We can conclude that although obesity is a risk factor for the development of thyroid cancer, higher BMI is only partially associated with more aggressive pathohistological features of thyroid cancer.

SUCCESSFUL REPOSITIONING PROCEDURE FOR BENIGN PAROXYSMAL POSITIONAL VERTIGO AFTER STAPEDOTOMY.

This report aimed to investigate the relationship after successful left-sided stapedotomy and postoperative benign paroxysmal positional vertigo (BPPV) due to vitamin D deficiency. A 56-year-old woman presented with a complaint of progressive hearing loss and tinnitus in the left ear without dizziness. A successful left-sided stapedotomy was performed, confirming the diagnosis of otosclerosis and closing the air-bone gap to less than 10 dB. Seven days after the stapedotomy, the patient reported dizziness, usually when turning to her left side in the bed. An electrophysiological assessment was performed to investigate vestibular function. Dix Hallpike maneuver showed a typical response, about 5 seconds after repositioning the head, and geotropic, torsional rotary nystagmus of about 30 seconds was registered. Vitamin D deficiency in serum was found. Complete symptom remission was achieved after 7-day-treatment with Epley's maneuver. As a postoperative vertigo complication, BPPV often remains unrecognized after stapes surgery. Canalith repositioning maneuver is treatment for BPPV. Determining serum levels of total calcium and vitamin D may play a significant role in monitoring and reducing the recurrence of dizziness.

Osteopontin Levels in Patients with Squamous Metastatic Head and Neck Cancer.

Background and Objectives: Increased osteopontin (OPN) concentrations in the plasma of patients with head and neck squamous cancer (HNSCC) have diagnostic significance, and it can indicate more aggressive biological behavior of cancer. The aim of this study was to determine OPN levels in patients with HNSCC of different primary locations and to assess its prognostic significance in metastasis development. Materials and Methods: This cohort study included 45 patients (41 male and 4 female patients) with HNSCC with different primary localization of head and neck. All patients underwent surgery-neck dissection. All patients were categorized according to the histological findings of the resected material and tumor-node-metastasis (TNM) classification system. After surgery, N categories were determined on the basis of histological features of resected material. Results: The histological findings of our patients showed: N0 in 11 patients, N1 in 8 patients, N2a in 4 patients, N2b in 14 patients and N2c in 8 patients. Plasma OPN values in all study participants ranged from 2.24 to 109.10 ng/mL. OPN levels in plasma of patients with negative nodes compared to the group of patients with positive nodes in the neck differed significantly (16.89 ng/mL to 34.08 ng/mL, respectively; p = 0.03). There were significantly lower OPN plasma levels in the group of subjects with histologically positive one lymph node in the neck (N1) compared to the group of patients with N2b histologically positive findings of resected neck material (10.4 ng/mL to 43.9 ng/mL, respectively; p = 0.02). Conclusions: The results have shown that growing N degrees of positive neck nodes classification were accompanied by growing values of plasma osteopontin. Osteopontin might be important for the development of neck metastases.

Presence of pepsin in laryngeal tissue and saliva in benign and malignant neoplasms.

OBJECTIVES: The current study was performed to determine the presence of pepsin in saliva and laryngeal tissue among participants with benign and malignant laryngeal neoplasms. STUDY DESIGN: Case-control study included three groups of patients with: (1) benign laryngeal neoplasms, (2) malignant laryngeal neoplasms and (3) control subjects without symptoms or signs of laryngopharyngeal reflux (LPR). METHODS: Eighty-one voluntary participants were included into study. They were recruited from a group of patients with histologically proven benign and malignant laryngeal neoplasms and in case of control subjects among patients with nasal septum deformation without symptoms of LPR. Morning saliva samples were collected preoperatively. Tumor biopsies were collected by directoscopy of larynx and the control samples from interarytenoid unit of larynx. All samples were analyzed by Enzyme-Linked Immunosorbent Assay (ELISA) and Immunohistochemistry. RESULTS: Pepsin was found in all samples of saliva and tissue biopsies in groups with malignant and benign neoplasms. The highest concentration of pepsin was found in a group of patients with malignant laryngeal neoplasms. Patients with benign laryngeal neoplasms had lower concentrations and the control subjects presented with the lowest concentration of pepsin measured from their saliva. Differences were not statistically significant. Immunohistochemical (IHC) analysis showed the largest number of high positive samples in the group of malignant lesions. CONCLUSION: These results suggest that pepsin and LPR can contribute to the development of benign and malignant laryngeal neoplasms. Further prospective studies, with far more patients, are necessary to prove the role of pepsin in multifactorial etiology of laryngeal neoplasms.

Characteristics of Malignant Thyroid Tumors: A Retrospective Study on 320 Patients.

Papillary thyroid cancer accounts for 80-85% of diagnosed thyroid cancers, while follicular, medullary, and anaplastic cancers are diagnosed significantly less frequently. This study aimed to show the characteristics of malignant thyroid tumors. In this retrospective study, we analyzed data from 320 patients who underwent thyroid surgery from January 2018 to December 2019. We recorded and statistically analyzed basic demographic data, data of the cytological and pathohistological findings, and tumor characteristics (size, multifocality, extrathyroidal and lymphovascular invasion). Thyroid cancer was diagnosed in 95 patients. The incidence of thyroid cancer was higher in women than in men, but without a significant difference (p=0.46). There was a significant difference between preoperative cytological findings and definitive pathohistological diagnosis (p=0.001). There was no significant difference between genders in tumor size, extrathyroidal and lymphovascular invasion, and multifocality. There were significantly more thyroid cancers with a lymphovascular invasion that were less than 2 cm in size (p=0.04). In our opinion, it is important to emphasize the value of early diagnostics and analysis of the malignant tumor characteristics that are major prognostic factors for survival in patients with thyroid cancer.

The AsSociation Between Type 2 Diabetes Mellitus, Hypothyroidism, and Thyroid Cancer.

This study aimed to investigate the association between type 2 diabetes mellitus (T2DM), antidiabetic therapy, hypothyroidism, and thyroid cancer. We analyzed data from 320 patients who underwent thyroid surgery for suspicion of cancer. The diagnosis of thyroid cancer was confirmed by histopathological analysis in 95 patients. No significant difference was found in the diagnosis of T2DM and hypothyroidism concerning the presence of thyroid cancer (p=0.13; p=0.85), nor in the gender of patients with T2DM and hypothyroidism with respect to the type of thyroid cancer (p=0.19; p=0.25). Patients with T2DM (Odds ratio [OR] 1.89; 95% CI, 0.856-4.163) and patients with hypothyroidism (OR, 1.05; 95% CI, 0.530-2.164) had higher prevalence of thyroid cancer, as did those who had both diagnoses combined (p=0.37; OR, 2.39; 95% CI, 0.333-17.278), compared with the patients who did not have those diagnoses. Men with T2DM (OR, 6.19; 95% CI, 1.180-32.513) had higher prevalence of thyroid cancer than women. Patients who were on oral antidiabetics (OR, 1.91; 95% CI, 0.804-4.512) had higher prevalence of thyroid cancer than those receiving insulin. According to the results of this study, we can conclude that there is an association between T2DM, hypothyroidism, oral antidiabetics, and thyroid cancer.

Differential Expression of TFF1 and TFF3 in Patients Suffering from Chronic Rhinosinusitis with Nasal Polyposis.

Trefoil family factor (TFF) proteins contribute to antimicrobial defense and the maintenance of sinonasal epithelial barrier integrity. Dysregulation of TFF expression may be involved in the development of chronic inflammation and tissue remodeling characteristically found in chronic rhinosinusitis with nasal polyposis (CRSwNP). Expressions of TFF1 and TFF3 were determined in specimens of middle nasal turbinate (MNT-0), bulla ethmoidalis (BE), and nasal polyps (NP) from CRSwNP patients (n = 29) and inferior nasal turbinate from a group of control patients (underwent nasal septoplasty, n = 25). An additional MNT sample was collected 6 months after functional endoscopic sinus surgery (FESS, MNT-6). TFF1 mRNA levels were significantly reduced in all specimens by approximately three- to five-fold, while TFF3 was increased in MNT-0, as compared with controls. Six months after surgery their levels were reversed to control values. CRSwNP patients with S. epidermidis isolated from sinus swabs showed upregulation of TFF3 in MNT and NP as compared with patients with sterile swabs. Target gene regulation was not affected by the presence of type 2 inflammation in patients with confirmed allergy. Results of this study imply participation of TFFs genes in the development of CRSwNP.

Kikuchi-Fujimoto disease: the first reported case in Croatia.

Kikuchi-Fujimoto disease (KFD) is an extremely rare disease known to have a worldwide distribution with higher prevalence among Japanese and other Asiatic individuals. KFD presents as benign and self-limited disorder, characterized by regional cervical lymphadenopathy with tenderness, usually accompanied with mild to high fever and night sweats. Less frequent symptoms include weight loss, nausea, vomiting and sore throat. Final diagnosis can only be determined on the basis of typical morphological changes in the lymph node, therefore lymph node biopsy is crucial for proving the diagnosis. Here we present a 16-year-old, native Croatian, Caucasian girl with KFD, as a first case of KFD reported in Croatia. We suggest that this disease should be considered as a possible cause of fever of the unknown origin followed by lymphadenopathy.

Influence of allergy and bacterial colonization on the quality of life in nasal polyposis patients.

Allergies and bacterial colonization are frequently found in patients with chronic rhinosinuitis with nasal polyposis (CRSwNP). The aim of this study was to identify patients with allergy and present microorganisms in ethmoid sinus among the patients with refractory CRSwNP undergoing surgical treatment at the University Hospital Centre Osijek, and to compare their life quality, defined by SNOT-20 analysis (sinonasal outcome test) to the rest of patients, and a control group consisting of patients undergoing septoplasty but free of allergy and/or CRS. An additional aim was to identify specific types and strains of microorganisms (bacteria and fungi) found in these patients, in order to compare them to other reports, and to revise the empirical antimicrobial therapy. In this paper we demonstrate a high incidence of bacterial colonization (83.3%) among CRSwNP patients. As in previous studies, gram positive aerobes were the most frequently isolated bacteria and all of them were covered by specific antibiotics given before the specimen collection. Allergy was found in only 20% of these patients, who presented with a reduced quality of life when compared to the control group and CRSwNP without allergy. Significantly more frequent dominant symptoms in these patients were cough, frustration and irritation. In the line with this finding is the objective assessment by endoscopy (Malm score) that showed more prominent nasal polyposis in allergy patients.

The significance of Helicobacter pylori in patients with nasal polyposis.

AIM: To determine the presence of Helicobacter pylori in nasal polyps and the transmission of H. pylori from stomach to nasal polyps. METHODS: In a prospective, controlled clinical research, 35 subjects with nasal polyps and 30 controls with concha bullosa (CB) were involved, and had been subjected to endoscopic sinus surgery (ESS). In the biopsies of removed polyps and CB, polymerase chain reaction (PCR) was used for detecting the H. pylori DNA. Blood samples of the test and control group were evaluated for H. pylori immunoglobulin (Ig) G and A antibodies by ELISA. The test and control group underwent esophagogastroduodenoscopy with taking biopsies from the stomach for PCR detection of H. pylori DNA. RESULTS: In blood samples, specific IgG and IgA antibodies to H. pylori were found in 30 (85.71%) of 35 polyp patients and in 16 (53.33%) of 30 controls. In 10 (28.57%) of 35 patients H. pylori DNA was identified in the nasal polyp tissue, but it was not detected in the CB specimens. H. pylori DNA was found in the stomach mucosa samples of all test and control group of subjects. Significant statistical difference was found in the H.pylori specific IgG and IgA between the test and control group (p less 0.006) and between the polyp and control biopsy specimens of H. pylori DNA by PCR (p less 0.001). CONCLUSION: This research points to the colonisation of nasal polyps with H. pylori, the transfer of H. pylori from stomach to nasal polyps and potential role of H. pylori in emergence of nasal polyps.

Exploring possibilities in nasal polyposis treatment at one Croatian hospital.

AIM: To validate different operative techniques commonly used for nasal polyposis (NP) treatment. METHODS: This is a retrospective study exploring data on the NP surgery during a five-year period at the Ear, Nose and Throat Department at Clinical Hospital Centre Osijek, Croatia. Data were analysed regarding patients' gender, age, type of the surgery performed, and possible recurrence. Recurrence rate among patients that were followed up during that period of time and operated by different techniques (FESS vs. classical polipectomy) was compared. RESULTS: Most frequently used operative technique was classical bilateral polypectomy, in 62.9% (154/245) of cases. The frequency of classical polypectomy was significantly decreased from 42/46 (91.3%) in 2006 to 34/60 (56.7%) cases in 2010, whereas the frequency of FESS in combination with classical polypectomy was significantly increased during that period (p<0.0001). Among patients with relapse that were followed up most of them were subjected to classical polypectomy at the time of their first surgery (9/10), thus implicating higher incidence of relapse in classically polypectomized patients. CONCLUSIONS: A higher incidence of recurrence in patients who underwent classical polypectomy implicates the need for additional precautions when choosing an operative technique. In addition, further investigation of NP and better understanding of etiology as well as the development of more specific drugs would be of great importance for the improvement of nasal polyposis treatment in the future.

Non-functional parathyroid gland carcinoma, a rare malignant tumor of the head and neck.

Carcinoma of the parathyroid gland is a very rare tumor of the head and neck. The largest number of carcinomas are discovered by chance. (intraoperatively, during surgery removal of the parathyroid gland are adenomas). Around 1% of the primary parathyreoidism is caused by the cancer of parathyroid glands. Only 10% of these rare tumors make up dysfunctional cancer of parathyroid glands. There have been 24 cases reported of this disease in the literature. The focus of our study is to present a case of this disease and to review the published literature to date.

Significance of the pepsin from the saliva in the diagnosis and treatment of laryngopharyngeal reflux disease.

Etiopathogenesis of the laryngopharyngeal reflux has not been sufficiently clarified. It is believed that damage to the lining of laryngopharynx in laryngopharyngeal disease occurs in the use of acid and pepsin. The diagnosis of reflux acidic 24-hour Dual probe pH-metry is considered the gold standard. However, since the laryngopharyngeal reflux is often non-acidic new diagnostic methods are been explored, safe diagnosis of the disease according to symptoms of this uncharacteristic disease. In our study on 45 patients with laryngopharyngeal disease, we have proved that tracking the value of pepsin in the saliva of a valuable diagnostic indicator of laryngopharyngeal reflux and a valuable indicator of the success of the treatment.

Angiosarcoma of the hypopharynx: case report.

Angiosarcomas are malignant neoplasias of rapid growth that emerge from endothelial cells. They are rarely found in the area of the head and neck and account less than 0.1% of all head and neck malignancies. In some cases it has been linked to trauma, radiation and angiectasia but the etiology mainly remains unknown. Here we report a case of angiosarcoma of pyriform sinus manifested by dysphagia and dysphonia. The patient underwent endoscopic hypopharyngeal excision followed by radiation therapy with a good result. Our patient remains tumor free after two years. The purpose of this article is to add another case of primary angiosarcoma of a rare site, the hypopharynx.

Impaired kidney function in rats six months after unilateral nephrectomy - an old story, a new perspective.

AIM: Despite of routinely practised living kidney transplantation, data on consequences and impact of unilateral nephrectomy on the quality of life and health of donors are scarce. The aim of the present study was to examine long-term changes and function of the remnant kidney after unilateral nephrectomy in an animal model. METHODS: Thirty six female Sprague - Dawley rats at 4 months of age were randomized into the three groups: unilaterally nephrectomized, sham operated and naïve rats. The nephrectomy was done at inclusion in the experiment and their blood was taken at inclusion and six months thereafter. RESULTS: There was a significant increase in serum creatinine concentrations six months after unilateral nephrectomy (39.7 ± 0.8 µmol/l) in comparison with the sham operated (30.1 ± 1.1 µmol/l) and the naïve rats (26.3 ± 3 µmol/l) (p ≤ 0.001). Serum sodium levels remained unchanged (p=0.116). Blood haemoglobin concentration did not differ between the three groups (p=0.115). CONCLUSIONS: Although it has been very well established that kidney possesses huge capacity to compensate severe loss of renal mass, our results implicate that renal function undergoes significant deterioration with time after unilateral nephrectomy. Fortunately, in everyday clinical practice we do not see severe renal dysfunction in patients with a single kidney. However, prolongation of the human life span in the future could face us with renal impairment in living kidney donors. Future examination of specific biomarkers in our rat model (e.g. growth factors) could support our findings.

Prevalence of metabolic syndrome in the interior of Croatia: the Baranja region.

Metabolic syndrome (MS), a constellation of metabolic risk factors associated with development of cardiovascular diseases and Type 2 diabetes (T2D), has emerged as a public health problem of enormous proportions in developed and developing countries. We have reported previously its prevalence in several island populations of the Eastern Adriatic coast of Croatia. In spite of leading a relatively traditional life style pattern including adherence to a Mediterranean diet, the prevalence of MS in these populations is high and comparable to that in developed nations. However, data on prevalence of MS among the mainland Croatian populations is limited. Therefore, we conducted a study in an outbred population comprising of Croats, Hungarians and Serbs from the Baranja region of mainland Croatia. Although this is an ethnically heterogeneous population, the constituent groups exchange mates and therefore, are not reproductively isolated. The life style patterns are also similar. Overall prevalence of MS, assessed by the National Cholesterol Education Program (NCEP) criteria, is 40% (35% in males and 42% in females) with Body Mass Index (BMI) as the predictor of obesity and 42% (52% in males and 39% in females) with Waist Hip Ratio (WHR) as the predictor of obesity. It is likely that, in addition to genetic risk factors, a host of environmental factors that include dietary habits and relatively urban life style in a modernized society have influenced the levels of the constituent metabolic traits leading to an increased prevalence of MS.

Research involvement, specialty choice, and emigration preferences of final year medical students in croatia.

AIM: To explore involvement in scientific research, choice of specialty, and readiness to emigrate among graduating medical students in Croatia. METHODS: A total of 312 out of 408 (76%) final year medical students of all Croatian Medical Schools (Zagreb, Rijeka, Osijek, and Split) graduating in 2004 answered a questionnaire designed for this study, including questions on scientific involvement, desired specialty, and emigration preferences. RESULTS: During undergraduate study, 71 (23%) students have been involved in scientific projects. However, only 27 of them (38%) succeeded in publishing their results. Students identified poor project management as the most common reason for publication failure. Specialty choice varied among the four medical schools in Croatia but internal medicine, pediatrics, and surgery were usually highly preferred in all schools. If they failed to get the desired specialty, 104 (33%) students would consider emigration. CONCLUSION: There is a clear need for improvement in the management of students' research projects in Croatia, enabling enthusiastic medical students to publish the results of their work and retain their interest in science. The analysis of change of the desired specialties throughout the undergraduate study suggests an increased interest in the "controllable lifestyle" specialties. Failure to get the desired specialty would result in emigration for many students.