Use of linked mucosal flap for lower lip reconstruction after human bite injury.

AIM: An alternative method of reconstruction of a lower lip defect is presented, using a mucosal flap taken from the upper lip. This approach leaves the skin intact and therefore avoids skin scarring, with its associated unpredictable healing. The upper lip mucosal flap applied to reconstruct the lower lip injury was identical to the injured tissue type. RESULT: The results were functionally and aesthetically excellent (as illustrated). CONCLUSION: This technique represents an excellent alternative to reconstruction of a damaged lip, with the benefits of minimal scar tissue formation and excellent aesthetic result.

Influence of meteorological conditions on post-tonsillectomy haemorrhage.

AIM: To evaluate the relationship between the incidence of primary post-tonsillectomy haemorrhage and the daily weather condition, over a five-year period. STUDY DESIGN AND SETTING: This was a retrospective study carried out in the ENT department of the Split University Hospital between January 2000 and December 2004. RESULTS: Out of 3377 patients undergoing tonsillectomy, primary post-operative haemorrhage occurred in 83 (2.5 per cent). The season, daily atmospheric pressure and daily change in atmospheric pressure did not have any significant influence on post-tonsillectomy haemorrhage incidence. However, there was a statistically significant increase in the incidence of primary post-operative haemorrhage when cyclonic conditions prevailed (p = 0.035). CONCLUSION: The incidence of primary post-tonsillectomy haemorrhage in our study population was 2.5 per cent. Avoiding tonsillectomy during cyclonic weather conditions may reduce the incidence of primary post-tonsillectomy haemorrhage.

[Snoring and obstructive sleep apnea]. / Hrkanje i opstruktivna apneja za vrijeme spavanja.

Snoring and obstructive sleep apnea are similar disorders in etiology, with differences in clinical presentation and treatment. 5-20% of young and 40-50% of older population are affected by either of these disorders. Etiology of snoring should be sought in the anatomic irregularities of commencing portions of the upper respiratory and gastrointestinal tracts, obesity, alcohol abuse, use of some medications as well as in the sleep architecture disturbance. Treatment success depends on correctly established diagnosis and precise localisation of anatomic irregularity implicated in snoring. A wide array of diagnostic tests exist some of which are mandatory while the others are used on a case-by-case basis. Treatment is either conservative or surgical. The success rate is 30-90% depending on the type and the management of disorder. An algorithm for diagnosis and treatment of snoring and obstructive sleep apnea is shown at the end of the paper.

Hyperbaric oxygen as a method of therapy of sudden sensorineural hearing loss.

Sudden hearing loss is a sensorineural hearing impairment, which develops over a period of few hours to a few days. Several theories have been proposed regarding the development of sudden sensorineural hearing loss. The incidence of sudden sensorineural hearing loss has been reported to range from 5 to 20 per 100,000 persons per year. Hearing loss is treated with drugs that provide better blood supply to the inner ear and decrease inflammation. The aim of this study is to examine the influence of hyperbaric oxygen therapy in treating sudden sensorineural hearing loss. The beneficial effects of HBO2 on sudden sensorineural hearing loss are probably achieved by an increase in the distribution of O2 dissolved per volume unit of blood circulating trough the regions affected by the lack of oxygen. Sessions were performed on 17 patients, with sudden sensorineural hearing loss that began within 10 days prior to the tests. In the hyperbaric chamber, all patients breathed 100% oxygen at 2.8 bars, for 60 minutes twice a day, either until recovered or for a maximum of 30 sessions. Of the total number of study participants, 12 were male and 5 were female, and their average age was 35.3 years (range: 18 to 68). Before the therapy, an average hearing value was obtained out of five basic frequencies. Hearing was found to be in the range of 61-93 dB in 12 patients, while 5 patients had hearing in the range of 41-60 dB. Following therapy with hyperbaric oxygen, the hearing level of 14 patients was within the range of 0-26 dB, two patients' hearing level increased to 27-40 dB, and one patient's hearing level remained in the range of 41-60 dB. The average hearing level for all patients and for all five basic frequencies was 67.8 dB before therapy, in comparison with 21.6 dB after oxygen therapy (p=0.0003). The average number of sessions in the hyperbaric chamber was 11.9 (range: 5 to 20). The therapy was taken well by all patients. The results of this study, as well as the results of similar studies performed by other authors, indicate for the necessity of performing an additional prospective, random, double-blind study of the effects of hyperbaric oxygen therapy on sudden sensorineural hearing loss, on a large number of patients.

Giant rhinophyma--a case report.

Rhinophyma is an uncommon condition that often results in both functional and cosmetic impairment. A 65-year old male with a huge rhinophyma, that had extremely grown in the last three years, is presented. The huge tumor was removed under local anaesthesia with electrosurgical knife preserving the alar cartilage. Both, the immediate and late result were satisfactory. The relevant literature is discussed.

Influence of betaxolol and timolol on the venous tone in glaucoma patients.

The aim of this study was the assessment of physiological venous reflexes in 40 glaucoma patients treated with topically applied timolol maleate 0.50% and betaxolol HCL 0.50%. They were divided into two groups of twenty each; one group being given timolol and the other betaxolol. The assessment of the venous tone was performed by testing venous reflexes. We found no statistically significant difference between timolol and betaxolol; however, when the influence of circulating catecholamines and the other vasoactive substances was excluded by suprasphygmatic insufflation of a pediatric cuff, a significant difference was found in the Valsalva's maneuver (125.5 +/- 8.1 vs 85.0 +/- 34.3 venoconstrictive units VCUs, p = 0.03). The IOP was significantly decreased in both treatment group, although the pressure reduction effect was more pronounced in the timolol group. Our study suggests that timolol and betaxolol have a slightly different mode of action on the venous side of circulation under topical medications. It is possible that the use of betaxolol topically may reduce a systemic venoconstriction.

Hyperbaric oxygen as a therapy of Bell's palsy.

The purpose of this study was to compare the therapeutic effects of hyperbaric oxygen (HBO2) to the effects of prednisone treatment in 79 subjects with Bell's palsy. Patients were randomly assigned either to the HBO2-treated group (n = 42) or to the prednisone-treated group (n = 37). The HBO2 group was exposed to 2.8 atm abs of 100% oxygen for 60 min, twice a day, 5 days a week and was given a placebo orally. The prednisone group was exposed to 2.8 atm abs of 7% O2 (equivalent to 21% O2 in air at normal pressure) following the same schedule as the HBO2 group; prednisone was given orally (total of 450 mg in 8 days). Subjects from both groups were treated in the hyperbaric chamber for up to 30 sessions or to complete recovery, and were followed up for 9 mo. At the end of the follow-up period, 95.2% of subjects treated with HBO2, and 75.7% of subjects treated with prednisone recovered completely. The average time to complete the recovery in the HBO2 group was 22 days as opposed to 34.4 days in the control group (P < 0.001). In the HBO2-treated group, at the beginning, the altered nerve excitability test (NET) was abnormal in five subjects; three of them had normal NET by the end of the follow-up period. In the prednisone group the NET was abnormal in nine subjects at the beginning and they had not recovered by the end of the follow-up (P < 0.05). Our results suggest that HBO2 is more effective than prednisone in treatment of Bell's palsy.

The effect of hyperbaric oxygen breathing on the visual field in glaucoma.

Following the hypothesis that chronic ischemia is the main cause of functional deficiency in glaucoma, a double blind clinical experiment was carried out to study the effect of hyperbaric oxygenation in 51 glaucoma subjects, of which 31 were in the experimental group and 20 in the control group. In the experimental group there was a significant improvement of visual fields (p < 0.05), whereas there was no change in the subjects in the control group. Hyperbaric oxygen did not have any influence on intraocular pressure. The achieved visual field improvements remained stable for 3 months (p < 0.05), except for I3 and I4 isopters of the left eye and I4 isopter of the right eye, while they were considerably reduced after 6 months (p > 0.05).

Cardiovascular reflex testing and pupil cycle time in open-angle glaucoma.

The aim of the study is to assess the value of function tests of the autonomic nervous system in open-angle glaucoma by testing the cardiovascular reflexes and pupil cycle time. The experimental group consisted of 19 glaucoma subjects with controlled intraocular pressure. The control group consisted of 20 healthy volunteers. The Valsalva test has proven to be considerably accurate in the assertion of autonomic dysfunction (p < 0.05). Pupil cycle time was significantly prolonged (p < 0.001). These results confirm the role of autonomic dysfunction in open-angle glaucoma.

[Immunologic studies of secretory otitis]. / Immunologische Untersuchungen der sekretorischen Otitis.

Evaluation of total serum proteins and RIST immunoelectrophoresis of immunoglobulins IgG, IgA and IgM were carried out on a group of 35 children of both sexes suffering from secretory otitis. The transudate aspirated from the middle ear was examined only by immunoelectrophoresis. The values for albumin and gammaglobulins were decreased for all the patients. The values for RIST were significantly lower than those where an allergic cause was present. The values for immunoglobulins in transudate were also significantly lower than normal.

[Effect of radiotherapy on the function of the parotid gland]. / Die Wirkung der Radiotherapie auf die Funktion der Ohrspeicheldrüse.

The incidence of adverse effects on radiotherapy in head and neck cancer is quite common. Some irradiation doses affecting parotid gland have been investigated. 38 irradiated cases and 12 non-irradiated cases constituting the control group have been included in the study. Histologic examination, sialography, scintigraphy and sialometry have been performed in all cases. The impairment of parotid gland is evident in the early stage and is aggravated with time. Glandular function is not reduced significantly by irradiation doses of 2000-3000 r. A marked functional reduction has been noted with irradiation doses of 5000-6000 r., and is variable in each individual. The reduced glandular function was particularly reduced in the early postirradiation period. The subsequent functional improvement is related to the remainder of less affected parenchyma, reduced inflammatory process and rapid growth of goblet cells in the walls of the outlet system compensating mucus deficit.

[The fascia and perichondrium in reconstructive surgery of the middle ear]. / Faszie und Perichondrium in der rekonstruktiven Chirurgie des Mittelohres.

Analysis of 140 patients operated on for chronic otitis media showed that the perichondrium possesses biological qualities similar to those of the fascia, although it is used less often. When using the fascia, perforations occurred in 16% of the operated patients, whereas when using the perichondrium the incidence was 20%. Improved hearing when using the perichondrium was observed in 69%, and when using fascia in 42%. Functional results with the perichondrium were much better than with the fascia.