Relationship between socio-demographic characteristics and vocal fold nodules, polyps and oedema.

The aim of our study was to compare socio-demographic characteristics of vocal fold nodules, polyps and oedema. The study included patients diagnosed for the first time with vocal fold nodules, polyps and oedema at the Communication Disorders Care Center of Clinic for Otorhinolaryngology and Maxillofacial Surgery in Clinical Center of Serbia, Belgrade. Diagnosis was made on the basis of symptoms, clinical otorhinolaryngological and phoniatric examination and endovideolaryngostroboscopic findings. A self-administered questionnaire was used to collect the following data: socio-demographic status, exposure to occupational noise and air pollution, occupational voice demands, health habits, symptoms of the present voice problems and voice problems in the family. By multivariate logistic regression analyses, nodules and oedema were more frequent in women than men in comparison with polyps (p < 0.001). Patients with nodules and polyps were younger than those with oedema (p < 0.001). Patients with nodules were more frequently lecturers, singers and actors compared with polyp patients (p = 0.006), had occupational voice demands more frequently than patients with oedema (p = 0.037) and were less frequently smokers than patients with polyps (p = 0.043) and those with oedema (p < 0.001). Patients with oedema were more frequently current smokers than patients with nodules and those with polyps (p < 0.001). Hoarseness as the main symptom was more frequent among patients with nodules than among patients with polyps (p = 0.040) and those with oedema (p = 0.001).Voice problems in the family was more frequently reported by oedema patients than by patients with polyps (p = 0.005). These findings are in agreement with majority of previous studies and may be of help in investigations on the aetiology of the disease.

[What do we need to help laryngectomized speeking?].

Multidisciplinary approach in rehabilitation of laryngectomized patients is the basic of esophageal voice and speech establishing. Well trained and dedicated stuff is cornerstone for such helpless patients. Communication Disorders Care Center and Laryngectomized Patients Society are minimal administrative precautions in organized community. Modern technology implementation gives us objective evaluation of therapy effects, that is 84% of successful treatment in our daily work.

[Diagnostic algorithm in patients with cervical metastasis of malignant tumours unknown primary location].

Carcinoma of unknown primary location are heterogeneous group of metastatic tumours where primary location could not be discovered with detail anamnesis, clinical examination and diagnostic procedures. Patients with metastasis carcinoma of unknown primary location in clinical oncology are represent with about 4% of total number of patients with solid tumours. The most frequent location carcinoma of unknown primary location, discovered with autopsy, are lungs, pancreas, colon, kidney, prostate and breast. Metastasis in cervical lymph nodes carcinoma of unknown primary location are represent between 3-9% of total number of patients with head and neck carcinoma. Patients with persistent cervical lymph node should be examined through diagnostical plan "step by step" for identification carcinoma of unknown primary location.

Nonvibrating segment predicting glottis carcinoma.

Endovideolaryngostroboscopy is the obliged evaluation tool in our everyday practice. Standardized protocol in management of broad spectrum of vocal pathology is useful in clinical, scientific and educational evaluation of patient from the first interview till the end of the treatment. Using of contemporary computerised multidimensional analysis of stroboscopic image we are approaching to optimum evaluation of any kind of interpersonal communication disorder. There were 66 patients in prospective clinical study of correlation between suspect endovideolaryngostroboscopic findings and histo-pathology verification of glottis carcinoma. Asymmetric and irregular vibrations with absent mucosal wave or absent vibrations of one part or of the whole vocal fold was improved as carcinoma in 85% of patients. The most frequent diagnosis was Ca planocellularae invasivum G2 NG 2, with subsequent open chordectomy. In every case of hoarseness longer more than 14 days, endovideolaryngostroboscopy is the golden standard for evaluating the need for microlaryngoscopy and biopsy.

[Phoniatricians aspect of international statistical classification of diseases and related health problems].

INTRODUCTION: In everyday phoniatrician practice there are problems in finding adequate coding in current version of International Classification of Diseases. There is grey area for additional explanation under the official diagnosis and its code in Computer program window, but that has bad consequences on efficacy in writing the final medical report. OBJECTIVE: Suggestions for solving this problem that can contribute in next Revision are presented. METHOD: The comparation between diagnoses in 7 years period of Phoniatric Department everyday practice and given diagnoses in current version of International Classification of Diseases. RESULTS: Certain percent of diagnoses that are overviewed during last 7 years in our Phoniatric Department has no adequate expression in given diagnoses in Tenth Revision. One can say that there is some kind of communication disorder. CONCLUSION: This is the moment for Communication Disorders Care Center experts to participate in constitution of widespread acceptable nomenclature. The role of phoniatrician is necessary and logical in this system. The phoniatrician aspect of contribution in next Revision, is presented.

[Functional results of treatment of early carcinoma in the glottic region of the larynx].

Early stage glottic cancer can be successfully treated with open surgery, LASER surgery or radiotherapy. During this treatment the physician obviously has to bear in mind principles of oncological radicality, but also, none the less, the preservation of all the functions of the larynx, and especially the preservation of voice quality. The aim of the study is to compare, in a specifically designed prospective study, the method of treatment with the functional results of basic characteristics of spoken voice of patients with early stage cancer of the glottis region. Then, based on the analysis of the results, to try and determine the most successful method of treatment. The first study group consisted of 72 patients operated using transoral laser microsurgery; the second study group consisted of 75 patients operated using open surgery; and the third study group consisted of 74 patients treated with radiotherapy. The voice quality is much better after laser chordectomy compared to open surgery chordectomy with reconstruction. Furthermore, the functional results of voice quality, after a laser chordectomy, are worse when compared to the group of patients treated with radiotherapy. Taking into account all objective and subjective phoniatric parameters, we determined that there is no crucial difference in the voice quality of patients operated using laser chordectomy and patients primarily treated with radiotherapy. From a functional point of view these two methods are superior to open surgery chordectomy.

[Dysphagia rehabilitation].

Dysphagia and aspiration are important problems among the elderly population, particularly in neurological patients and patients with cancers of the oropharingeal area or laryngs. Early detection and rehabilitation are crucial because adequate management can reduce morbidity and complications like aspiration pneumonia, dehidratation and malnutrition. We overviewed rehabilitation procedures including nutritional management, postures, maneuvers, exercises and stimulation techniques and their efficacy in treatment of patients with dysphagias.

Vocal fold masses removal--the sub epithelial micro flap technique.

Vocal fold mass removal techniques were significantly modified back in 1970s by Hirano's laminar vocal structure and physiology of phonation works, as well as Titze's vibratory vocal cycle works. New methods were to come. Removing the lession by maximum preservation of vocal laminar microstructure (lamina propria and epithelium) and minimal damage of surrounding normal vocal tissue, was pointed out. Microflap technique is based on presenting the superficial layer of lamina propria with the lesion and removing the lession without damage of the mucosa. Preserving of the mucosal layer provides the shield for vibratory substructures. There are two elementary approaches for microflap: lateral and medial. Lateral microflap technique enables better identification of vocal ligament and lowers the risk of it's injury, particulary when scars and tightly adherent lessions are present. This technique has been used in case of big or diffuse lesions, such as vocal oedema or vocal lygament identification difficulties (e.g. vocal scarification). Medial microflap technique seems to be appropriate in removing smaller, localised lessions, such as cysts and vocal polyps. Our 45 patients experience is presented in this article, in 30 patients lessions were removed by lateral microflap technique (46 vocal cords in total), while 15 patients were treated by medial microflap technique. The outcome was assumed by endovideolaryngostroboscopic analysis of glottal occlussion and mucosal wave prior and following to the procedure. Reinke oedema management results were analysed separately.

Conservative treatment vs phonosurgery.

In Phoniatric Dpt. everyday practice we try to keep specific multidisciplinary approach to the communication disorders, that includes an expert team using modern technology. Over the last six years we have treated 110 singers (3% of all new cases) and the results of their diagnostic and therapeutic management are presented here. There were 67 women and 43 men, 41 were smokers and 69 nonsmokers. The singing genres included 24 pop, 41 folk, 8 ethnic, 29 choral and 8 opera singers. The therapy success was compared with the demographic parameters, level of education and music genres across the subjects. A precise history, clinical examination, endovideolaryngostroboscopy and multidimensional computer analysis of voice and speech was carried out by two phoniatricians, two logopeds, two nurses and one clinical psychologist. Additional consultations were carried out by audiologists, allergists, endocrinologists, chest physicians, gastroenterologists and neurologists where necessary. We suggest that the gold standard is conservative therapy, with phonosurgery if conservative measures fail. We also suggest that an annual systematic examination is optimal in preventing disease in professional singers.

Preliminary characterization of lactic acid bacteria isolated from Zlatar cheese.

AIMS: Isolation, characterization and identification of lactic acid bacteria (LAB) from artisanal Zlatar cheese during the ripening process and selection of strains with good technological characteristics. METHODS AND RESULTS: Characterization of LAB was performed based on morphological, physiological and biochemical assays, as well as, by determining proteolytic activity and plasmid profile. rep-polymerase chain reaction (PCR) analysis and 16S rDNA sequencing were used for the identification of LAB. PCR analysis was performed with specific primers for detection of the gene encoding nisin production. Strains Lactobacillus paracasei subsp. paracasei, Lactobacillus plantarum, Lactobacillus brevis, Lactococcus lactis subsp. lactis, Enterococcus faecium and Enterococcus faecalis were the main groups present in the Zlatar cheese during ripening. CONCLUSIONS: Temporal changes in the species were observed during the Zlatar cheese ripening. Mesophilic lactobacilli are predominant microflora in Zlatar cheese. SIGNIFICANCE AND IMPACT OF THE STUDY: In this study we determined that Zlatar cheese up to 30 days old could be used as a source of strains for the preparation of potential starter cultures in the process of industrial cheese production. As the Serbian food market is adjusting to European Union regulations, the standardization of Zlatar cheese production by using starter culture(s) based on autochtonous well-characterized LAB will enable the industrial production of this popular cheese in the future.

[Effect of the extents of surgical resection in total laryngectomy on esophageal voice and speech rehabilitation]. / Uticaj obima hirurske resekcije kod totalne laringektomije na uspostavljanje ezofagusnog glasa i govora.

The study of functional results of total laryngectomy cannot be separated from articulation of esophageal voice and speech. To achieve success of phoniatric rehabilitation in laringectomized patients, it is necessary to be well aware of pathological sequelae of the very operation, long-term adverse effect of oncological risk factors as well as postoperative anatomo-physiological changes. Anatomic results of total laryngectomy depend on the type of surgical intervention and probable radiotherapy. The extent of surgical procedure, primary dictated by oncological indications, has the essential effect to articulation of esophageal voice and speech. If possible for oncological reasons, hyoid bone should be particularly left intact. Extensive surgical interventions of hypopharynx and the base of the tongue during laryngectomy, neck dissection--especially the radical one, and subsequent radiotherapy, all of them significantly reduce the possibility to produce esophageal voice and speech. Total laryngectomy eliminates the creator of voice and vibrations, which are acoustically perceived as esophageal voice, proceeding at the level of pharyngoesophageal junction. For this reason, the quality of newly created vibrating narrowing is especially important.

Characterization of natural isolate Lactobacillus acidophilus BGRA43 useful for acidophilus milk production.

Lactobacillus acidophilus BGRA43 was selected from a set of human origin isolates of Lact. acidophilus strains for the highest growth rates and antagonistic effect against both Gram-positive and Gram-negative bacteria. The strain BGRA43 also exhibited an inhibitory effect on the growth of Clostridium sporogenes. Inhibition of this strain seems to be due to lactic acid production rather than hydrogen peroxide or bacteriocin. Growth of Lact. acidophilus BGRA43 in non-fat skim milk for 6 h at 37 degrees C resulted in a lowering of the pH value to 4.53. Besides the fast acidification, this strain generated a high viscosity of skim milk. These characteristics make the strain BGRA43 attractive for acidophilus milk production. Lactobacillus acidophilus BGRA43 produces an extracellular proteinase. Whole cells efficiently degraded casein for 3 h at 37 degrees C especially alpha- and beta-casein fractions. Total DNA isolated from the strain BGRA43 did not show any hybridization with lactococcal proteinase probes indicating that this strain produces a distinctive proteinase.