Variations in concerns reported on the patient concerns inventory in patients with head and neck cancer from different health settings across the world.

BACKGROUND: The aim was to collate and contrast patient concerns from a range of different head and neck cancer follow-up clinics around the world. Also, we sought to explore the relationship, if any, between responses to the patient concerns inventory (PCI) and overall quality of life (QOL). METHODS: Nineteen units participated with intention of including 100 patients per site as close to a consecutive series as possible in order to minimize selection bias. RESULTS: There were 2136 patients with a median total number of PCI items selected of 5 (2-10). "Fear of the cancer returning" (39%) and "dry mouth" (37%) were most common. Twenty-five percent (524) reported less than good QOL. CONCLUSION: There was considerable variation between units in the number of items selected and in overall QOL, even after allowing for case-mix variables. There was a strong progressive association between the number of PCI items and QOL.

The Quality of Life of Patients with Surgically Treated Mandibular Fractures and the Relationship of the Posttraumatic Pain and Trismus with the Postoperative Complications: A Prospective Study.

Background and objectives: Due to the fact that the mandible is the only movable bone in the face, it is often exposed to the influence of external forces. The incidence of trismus and posttraumatic pain in unilateral mandibular corpus fractures may be related to the occurrence of complications. There is a decrease in the quality of life of these patients. The aim was to study the relationship of the preoperative pain and trismus with the incidence of complications, as well as to investigate the quality of life. Materials and Methods: A prospective study on 60 patients with isolated mandibular fractures was performed, with a follow-up period of six months. The level of preoperative pain was measured on a 0-10 scale, while the mouth opening was measured with a caliper. All patients were treated surgically on the third day after the fracture. The University of Washington Quality of Life (UW-QOL v4) questionnaire was used to analyze the quality of life. Results: The most common types of complications were the occlusal derangement and facial asymmetry. The majority of complications were treated with counseling and physical therapy. The degree of preoperative pain was significantly positively related to the onset of complications (rs = 0.782, p = 0.004). The interincisal distance showed a significant inverse relation with the incidence of complications (rs = -0.722, p < 0.001). The patients regarded the pain, appearance and mood issues as the most important issues during the first postoperative month. Conclusions: The degree of inflammatory symptoms may be positively related to the onset of complications occurring after the rigid fixation of mandibular fractures. The postoperative health-related and overall quality of life was unsatisfactory in nearly half of the patients.

Trauma of the Frontal Region Is Influenced by the Volume of Frontal Sinuses. A Finite Element Study.

Anatomy of frontal sinuses varies individually, from differences in volume and shape to a rare case when the sinuses are absent. However, there are scarce data related to influence of these variations on impact generated fracture pattern. Therefore, the aim of this study was to analyse the influence of frontal sinus volume on the stress distribution and fracture pattern in the frontal region. The study included four representative Finite Element models of the skull. Reference model was built on the basis of computed tomography scans of a human head with normally developed frontal sinuses. By modifying the reference model, three additional models were generated: a model without sinuses, with hypoplasic, and with hyperplasic sinuses. A 7.7 kN force was applied perpendicularly to the forehead of each model, in order to simulate a frontal impact. The results demonstrated that the distribution of impact stress in frontal region depends on the frontal sinus volume. The anterior sinus wall showed the highest fragility in case with hyperplasic sinuses, whereas posterior wall/inner plate showed more fragility in cases with hypoplasic and undeveloped sinuses. Well-developed frontal sinuses might, through absorption of the impact energy by anterior wall, protect the posterior wall and intracranial contents.

Morphometric analysis of the stylohyoid complex.

PURPOSE: Stylohyoid complex is anatomical structure predisposed to numerous individual variations. These may result in its extreme elongation, medial deviation and finally Eagle's syndrome occurrence. The aim of this study was to measure the length, angulation, evaluate morphological variations of stylohyoid complex by computed tomography and, subsequently, relate obtained data to the gender and the age of the evaluated cases. MATERIALS AND METHODS: The material included CT scans of stylohyoid complexes of 282 individuals. The entire length, maximal thickness, and angulation of the stylohyoid complexes in the coronal, transverse, and sagittal planes were measured. RESULTS: According to their morphology, orientation and length, stylohyoid complexes were classified into six morphological types. Elongated, bent, segmented, and segmented with attached stylohyoid ligament for the lesser horns of the hyoid bone stylohyoid complex types were characterized by significantly greater length, while pseudoarticulated type was characterized by significantly lower length in relation to normal stylohyoid complex type. The elongated type was additionally significantly thicker and with significantly lower value of medial angle in transverse plain than the normal stylohyoid complex type. Elongated, bent, and segmented types were significantly more frequent in males than in females. Furthermore, the frequency of the elongated stylohyoid complex type increased, whereas normal and pseudoarticulated types decreased with age. CONCLUSIONS: In conclusion, elongated and more medially deviated stylohyoid complexes are more frequent in males than in females. Their more frequent presence in the older age groups indirectly connects this phenomenon with the aging process.

Rare Disease: Lobar Holoprosencephaly With a Median Cleft Lip-Case Report.

Holoprosencephaly is a complex malformation of the brain associated with the median facial defects. Variability of the clinical picture is the characteristic of this anomaly. In most cases, the degree of severity of the facial anomaly correlates with the degree of damage to the brain. This article aims to present a rare case of child with a milder form of brain anomaly combined with a severe form of facial anomaly. The article also presents the application of a feeding stimulator to improve the child's quality of life. The anomaly was diagnosed by postnatal sonography of the brain, magnetic resonance imaging of the endocranium, and three-dimensional computed tomography of the craniofacial skeleton.

Alternaria-Associated Fungus Ball of Orbit Nose and Paranasal Sinuses: Case Report of a Rare Clinical Entity.

Alternaria-associated fungus ball of maxillar, ethmoidal paranasal sinuses, nasal cavity and orbit with bone erosion is extremely rare. Till recently, only two cases of this infection in immune competitive patients have been reported. We are herein describing the case of immune-competent woman who suffered of nasal congestion for 10 years. Patient was treated for tumor-like lesion in right maxillar sinus, where propagation in right nose cavity, right ethmoidal cells and right orbita was present. The organism that was seen in surgical removal of fungal debris by histological study, in using mycological testing, was proven as Alternaria alternata. Combination of surgical intervention and treatment with itraconazole eradicated fungal infection, and the disease was not relapsed in follow-up period of 2 years.

[Association between chronic periodontitis and serum lipid levels].

BACKGROUND/AIM: Periodontitis is a local inflammatory process mediating destruction of periodontal tissues triggered by bacterial insult. However, this disease is also characterized by systemic inflammatory host responses that may contrbute, in part, to the recently reported increased risk for systemic diseases, including an altered lipid metabolism. On the other hand, many people in the world are affected by hyperlipidemia, which is a known risk faktor for atherosclerosis. The aim of this study was to determine the relationship between periodontal disease and blood lipid levels. METHODS: A total of 50 patients with periodontitis included in this study had no documented history of recent acute coronary events. The healthy, non-periodontal subjects (comparison group) comprised 25 subjects. All the patients were periodontology examined and completed a medical history. Dental plaque index, probing depth, gingival index bleeding on probing and clinical attechment levels were recorded. Blood samples were taken on admission for measurements of serum total cholesterol, triglycerides, hight density lipoprotein cholesterol (HDL-cholesterol), and low density lipoprotein cholesterol (LDL-cholesterol). RESULTS: The obtained results showed that mean levels of cholesterol (6.09 +/- 1.61 mmol/L), triglycerdes (2.19 +/- 1.67 mmol/l) and LDL cholesterol (4.09 +/- 1.40 mmol/L) in individuals with periodontitis were higer, and levels od HDL (1.43 +/- 0.51 mmol/L) was lower than those of individuals without periodontitis (4.86 +/- 1.37; 1.14 +/- 0.71; 3.18 +/- 0.64; 1.53 +/- 0.32 mmol/L, respectively). CONCLUSION: This study confirms a significant relationship between periodontal disease, regardless its intensity, and blood lipid levels in the studied population. The results imply that periodontitis may be a risk factor and may contribute to the pathogenesis of atherosclerosis and cardiovascular diseases (CVD). However, future prospective randomized studies have to determine whether periodontal disease is a risk factor for the occurence of CVD.

Use of 2-Octyl-Cyanoacrylate in surgical closing of Postparotidectomy salivary fistulas.

A salivary fistula is one of possible postoperative complications in the surgery of parotid gland tumors. We present three cases of postparotidectomy salivary fistulas, successfully treated by surgical access using 2-octyl-cyanoacrylate while closing the skin layer. The previous treatment of these cases by other therapeutic options did not give satisfactory results. In a 5-year follow-up period there were no signs of fistulas relapses. The surgical access with use of 2-octyl cyanoacrylate can be one of therapeutic options for the closing of postparotidectomy salivary fistulas, especially in cases where other therapeutic accesses are not successful.

Effect of periodontal treatment on lipoproteins levels in plasma in patients with periodontitis.

OBJECTIVES: Recent epidemiological studies have shown that individuals with periodontitis have a significantly increased risk of developing coronary heart disease. In addition to conventional risk factors, dyslipidemia may be associated with this increased risk. METHODS: We measured concentration of lipids in patients with moderate to severe periodontitis before and 3, 6 and 12 months after local periodontal treatment. A total of 50 participants with periodontitis and 25 participants without periodontitis were included in the analyses. Lipoproteins were measured by using serological analyses of the Central Biochemical Laboratory in Clinical Center in Nis. Periodontal health indicators included the plaque index, gingival bleeding index, and periodontal disease status (defined by pocket depth and attachment loss). Patients were non-surgically treated with mechanical debridement of calculus once a week for 1 month. RESULTS: The results show a significant relation between indicators of poor periodontal status and serum level lipoproteins. Periodontal therapy resulted in a significant reduction of local inflammation and tissue destruction as reflected in reduced pocket depth and reduced bleeding indices. The levels of lipoproteins after therapy seemed to be lower than those reported before treatment in patients with periodontitis compared with healthy ones. Lipoproteins were significantly decreased after treatment (P < 0.005) except high-density lipoprotein cholesterol which was not significantly reduced (P > 0.05). CONCLUSION: This pilot study shows that periodontal disease significantly affects the serum levels of lipoproteins and suggests that following successful periodontal treatment decreases serum lipid concentration. This study suggests also that lipoproteins are possible intermediate factors that may link periodontal disease to elevated cardiovascular risk.

[Macroglossia and Beckwith-Wiedemann syndrome].

INTRODUCTION: In 1963 Beckwith presented a report on the first patient with extreme cytomegaly of adrenal cortex, hyperplasia of kidneys and pancreas and Leydig cell hyperplasia. Wiedemann completed description of the new syndrome by adding umbilical hernia and macroglossia. The diagnosis is made based on the clinical signs of omphalocele or some other umbilical deformity, macroglossia, congenital asymmetry, visceromegaly (liver, pancreas, and kidneys). CASE OUTLINE: A 16-month-old male child was admitted for examination because of macroglossia. He underwent examination on several occasions by an endocrinologist due to recurrent hypoglycaemic crisis. The patient was observed by a paediatric neurophysicatrist for disorders of mental development. Hypoglycaemia, muscular hypotonia of the anterior abdominal wall with umbilical hernia and macroglossia were observed by clinical examination. Inratraoral examination revealed macroglossia with microstomia, suckling and swallowing difficulties, hypotonia of the perioral muscles with increased salivation. It was therefore decided to perform surgical reduction of the prominent tongue and develop good condition for nutrition, speech function and the development of orofacial system. CONCLUSION: The diagnosis of macroglossia is based on subjective clinical criteria such as the morphology and amount of protrusion of the tongue, difficulty in articulating sounds, breathing, and hypersalivation. Some authors have suggested that the tongue size may be analyzed radiographically with a cephalogram. Treatment of macroglossia is controversial because of the absence of objective clinical criteria.

White blood cell count in different stages of chronic periodontitis.

Periodontal disease is considered to be an inflammatory disorder that is related to the accumulation of oral microbial biofilm and the host response to this accumulation. The host reaction to gingival microorganisms is characterized in part by increase in the polymorphonuclear leukocyte counts, which is one of the most important steps in host defense. Exaggerated leukocytes and neutrophils of host response are a very important component in the pathogenesis of periodontal disease. The purpose of this study was to investigate the relationship between white blood cell count and periodontal disease in subjects with moderate and severe periodontitis and in control subjects with healthy periodontal tissues. Leukocytes for the present study were obtained from peripheral venous blood of 50 patients with moderate periodontitis, 50 patients with severe periodontitis and 25 healthy subjects. The clinical parameters of periodontitis including plaque index, bleeding on probing and gingival index were determined in all study subjects. In both moderate and severe periodontitis, the results indicated a significantly higher count ofneutrophils (P < 0.001), as well as of both lymphocytes and total leukocytes (P < 0.05). The values of clinical parameters (plaque index, gingival index and bleeding on probing) also showed significant between-group differences (P < 0.005 and P < 0.001, respectively). It is possible that there is a significant relationship between total leukocyte count, neutrophil count and different forms of periodontal disease.

[Microvascular submental island flap prelaminated with oral mucosa in reconstruction of the lateral defect of nose].

INTRODUCTION: Reconstruction of perinasal area is still a challenge for the surgeon who is involved in excisional tumor surgery. The authors report their experience in reconstruction of hemi-nose defects with the free microvascular submental island flap prelaminated with oral mucosa. MATERIAL AND METHODS: A 73-year-old male patient with recurrent extensive basal cell carcinoma of the right hemi-nose (nasal ala and lateral nasal part) and portion of the upper lip underwent to excisional surgery and creation of lateral nasal defect 3 x 2 cm in size. Six months after the first surgery the reconstruction of postoperative defect was done by means of free microvascular submental flap prelaminated with oral mucosa. RESULTS: After necrosis of flap 3 mm x 4 mm in size around the tip zone of the nose on the 7" postoperative days, the rest of microvascular submental flap prelaminated with oral mucosa survived completely with good cosmetic and nasal respiratory results. CONCLUSION: This flap can be used successfully in reconstruction of the hemi-nose area. Color and texture of the flap match with adjacent tissue and adequate diameter of submental vessels and reasonably long vascular pedicle enables successful microvascular anastomosis.

[The relationship between clinical findings and therapeutic approach in the treatment of fractured frontal sinus walls].

INTRODUCTION: The incidence of fractured frontal sinus walls vary from 6% to 12% of all craniofacial injuries. OBJECTIVE: Estimated relation between clinical findings and performed therapeutic procedures in treating fractured frontal sinus walls. To estimate success in performed therapeutic procedures, according to the incidence of postoperative complications and the integrity of injured regions from the functional and esthetical aspect. METHOD: We analyzed, by retrospective clinical investigation, 19 patients with fractured frontal sinus walls and dislocated fragments, treated at the Department for Maxillofacial Surgery, Clinic of Dentistry in Nis, in the period March 1995-March 2006. The success of therapy was estimated based on the incidence and type of complications and esthetical results in relation to preoperative findings. RESULTS: Predominant etiological factor in fractures of frontal sinus walls is trauma sustained in traffic accidents, which occurred in 52.6% of patients in our investigation. In clinical findings, the impression was the predominant sign, present in 16 patients. In 6 cases soft tissue access through already present lacerations or their extensions was employed, in 4 cases it was done by supraciliary access and in 9 by bicoronal access. As a therapeutic measure, drainage was performed in 5 cases, cranialisation in one, ostheoneogenetic access in 11 cases and a simple reposition of fragments in 2 patients with fractured frontal sinus walls. Infection as a complication was absent. All patients were satisfied with postoperative esthetical appearance of the injured region. CONCLUSION: The infection, the lacerations and the direction of fractured lines are dominant factors in the determination of therapeutic procedures used to treat fractured frontal sinus walls. This will result in the low incidence of infection as a postoperative complication and in patient's satisfaction with postoperative esthetical result of the injured region.

[Prognostic significance of sinus deceleration during dobutamine stress echocardiography test following acute myocardial infarction].

BACKGROUND/AIM: Chronotropic incompetence during exercise stress testing after acute myocardial infarction is an indicator of ischemia or impaired left ventricular function. On the other side, infusion of dobutamine leads to a typical dose-dependent increase in heart rate. The aim of this study was to evaluate of paradoxical sinus deceleration during dobutamine stress echocardiography (DSE), as the sign of ischemia and impaired left ventricular function, or the consequence of infarction localization, and the estimation of prognostic significance after acute myocardial infarction. METHODS: Our investigation comprised 81 patients hospitalized because of the acute myocardial infarction, and all of them had uncomplicated infarction. Fifty five patients were treated with thrombolytic therapy (67.9%); 53 patients (65.4%) had anterior myocardial infarction, and 28 patients (34.6%) had inferoposterior localization of myocardial infarction. After 10-12 days all of them underwent dobutamine stress echocardiography examination. During the next 3-6 months, the patients underwent coronary angiography. The average follow-up period was 36 +/- 22 months. RESULTS: A decrease in heart rate occurred at the dobutamine doses increasing from 15-40mcg/kg/min in 9 (11.1%) of the patients, in 1 patient with an anterior localization and in 8 patients with an inferoposterior localization. The decrease was sudden in 4 (44.4%), and gradual in 5 (55.6%) of the patients. In 3 patients (33.3%) junction rhythm was developed, and in 2 patients (22.2%) AV block II-III. Only in 2 of them, there was a worsening of regional function during a high dose dobutamine infusion, but 7 of them showed an improvement during a low dose. In 7 (77.8%) of the patients there was a simultaneous decrease in blood pressure. Coronary angiographic examination showed that in 4 (44.4%) of the patients there was a significant coronary artery disease and they underwent the revascularisation procedure. During the follow up period, there was not any significant arrhythmic disorder in that group of the patients or repeated hospitalization because of postinfarction angina, re-infarction, or heart failure. CONCLUSION: We could conclude that paradoxical sinus deceleration is not only an indicator of a significant coronary artery disease and "bad left ventricle". It also may occur as a consequence of vasodepressor reflex (Bezold-Jarisch), even after acute myocardial infarction, withont influencing a long-term prognosis.

[Ultrasonography and surgical treatment of facial skin neoplasms]. / Ultrazvuk i hirurska terapija tumora koze lica.

In the second half of the 20 century, echosonography has been used in many medical specialities. In 1992 and 1993 highfrequencies echosonography was used in the examination of irritant and allergic skin lesions in order to examine the effects of different therapeutical agents on the skin lesions [1-4]. Hoffmann used highfrequencies echosonography in the examination of healing of skin lesions [3]. By their incidence skin tumours are the largest group of newly discovered tumours, and their usual location is on the face [5-7]. By clinical examination it is not possible to precisely determine the depth of tumour border; therefore, the radically performed surgical excision is the only correct surgical treatment. The aim of this study was to estimate the results of preoperatively performed high frequencies echosonography in order to reduce the number of incorrectly performed surgical excisions of skin tumours. The group was composed of 40 patients with 45 tumours, who first underwent echosonographic diagnostic procedure (20 MHz, Hadsund electronic, Hadsund Technology, Denmark) and then surgical excision; patients in control group (45 patients with 45 tumours) were only subjected to surgical excision. Excised tumours were then pathohistologically analyzed, and measurements of tumour depth progression were performed. Margins of pathohistological specimen were controlled for the presence of tumour cells. Results of measurements of tumour depth obtained by echosonography and pathohistological measurements were compared. By Jate's modification of c2 test results regarding correct and incorrect surgical excision in patients and control group were compared. By linear regression analysis results of tumour depth obtained by echosonographic and pathohistologic examinations were compared. Hypoechogen zone echosonographic results were used like criteria for tumour expansion. Results of tumour depth measurements are presented in Table 1. Linear regression analysis showed (R = 0.64) that echosonographic examination gave objective pictures of tumour depth. Six specimens were excluded from this examination, and only the presence of tumour cells on specimen margins were analysed. All tumours in patients were excised radically; in control group tumour cells were present on pathohistological specimens margins of six cases. In comparison p = 0.5016 was a not significant value. Success of 100% of specimens correctly excised in operated patients is the success which is very close to success of Moh's micrographic surgery (by Fleming only 1% of tumour relapse in a five-year follow-up period) [8]. Result of 13.33% of incorrect excision in control group is close to results obtained by Leshin and al [9]. Result of p = 0.05016 is not statistically significant, but is very close to statistically significant values. This might require future examinations in a larger group of patients. Results of R = 0.64 correlate with results obtained by Hoffmann [3], because they show that highfrequencies ultrasound examination gives an objective picture of skin tumours depth. Results of this examination show that preoperative highfrequencies ultrasound examination can determine the progression of tumour depth, and give to surgeon data which can help him to perform correct surgical excisions.