Pilocarpine in the prevention of postirradiation xerostomia.

During radiation therapy to the head and neck region, salivary gland hypofunction commonly develops. The aim of our study was to evaluate whether the sialogogue pilocarpine given during radiation therapy may reduce the severity of xerostomia and salivary dysfunction. Our results showed the pilocarpine-treated group to have a lower frequency of oral symptoms during the treatment than the placebo-treated group. Although salivary flow decreased in all patients, the pilocarpine-treated group had smaller flow reductions. No drug effect was observed in the glands that were completely irradiated. Thus, pilocarpine appeared to stimulate salivary tissues outside the radiation field.

Clinical interpretation of brainstem evoked response audiometry abnormalities in cochlear pathology.

This investigation involved 45 patients with sensorineural hearing loss (SNHL): 24 with Meniere's disease, 18 with acoustic trauma, and 3 with SNHL due to ototoxic drugs. They all underwent pure tone audiometry and standard brainstem evoked response audiometry (BERA). In patients without wave I in auditory brainstem response, electrocochelography (ECochG) was performed. The findings are presented showing that cochlear lesions (beside threshold elevation) cause latency prolongation of wave I, III and V relative to normal latencies at the actual click hearing level. At high stimulation levels, this effect is almost completely compensated for by the fact that cochlear recruiting ears exhibit steeper latency-intensity curves than do normal ears. But, at the same time this pathology does not cause latency prolongation of central conduction time (CCT). Beside this, cochlear lesions will cause, in some cases, deterioration of replicability (poor waveform resolution) of waves preceding wave V. In such cases, the authors strongly recommend electrocochleography (ECochG) to make wave I visible, because they think that it is the best way to verify the diagnosis of cochlear lesion using BERA.

Patients with analgetic nephropathy on chronic hemodialysis have a high incidence of severe secondary hyperparathyroidism.

Between 1996 and 1997, 86 patients were treated for terminal renal failure by hemodialysis at Maribor Teaching Hospital. Among them were 12 with iPTH over 900 pg/ml and symptoms of bone disease. In these patients bone biopsy was carried out with the aim of determining the type of renal osteodystrophy (RO) and establishing a possible correlation with the clinical picture, with densitometry and laboratory results. Histomorphologically, 6 patients fulfilled the criteria for secondary hyperparathyroidism (HT) - 3 with analgetic nephropathy (AN), one with chronic pyelonephritis (CPN), one with vascular nephropathy (VN), one with chronic glomerulonephritis (CGN). Six patients fulfilled the criteria for mixed osteodystrophy (MO) - 3 AN, 2 CGN, one VN. According to laboratory findings and bone mineral density (BMD), a statistically significant difference between HT and MO was present only in AP (Table 1). The most frequent diagnosis in patients with iPTH >900 pg/ml was analgetic nephropathy.

[Bilateral glomus caroticum tumors]. / Bilateralni tumori karotickoga glomusa.

Paragangliomas of the head and neck are tumors which are believed to function as chemosensory reflex receptors that respond to changes in their chemical environment. They may occur in the carotid body, on the vagus nerve, along the jugular vein, in the middle ear, in the orbit, in the larynx and nasopharynx. The incidence of multiple paragangliomas is about 3% of all the patients with this tumor and 26% of the patients with positive family history.

Laryngeal cancer and blood selenium levels.

Blood selenium concentrations in 43 patients with laryngeal cancer and 47 normal subjects were determined by atomic absorption spectrophotometry. No significant differences in selenium values were observed in sera from the cancer patients when compared with controls, but there were significant differences between patients with advanced (T4) supraglottic cancers and the normal controls. These results suggest that lower blood selenium levels in this latter group of laryngeal cancer patients may be a consequence of their disease rather than its cause.

Oxalosis associated with aluminum bone disease: a new type of mixed renal osteodystrophy.

An 18-year-old man suffering from uremia was hospitalized because of severe skeletal pain and multiple exostoses. The patient had been treated for 5 years by regular hemodialysis; primary oxalosis was the suspected cause of uremia. Transiliac bone biopsy and subsequent histomorphometric analysis of undecalcified bone specimen as well as specific aluminum staining revealed a picture of oxalosis combined with osteomalacia and a marked accumulation of aluminum at the front of mineralization. This combination of histological features of oxalosis and aluminum bone disease suggests a new type of mixed renal osteodystrophy.

Nasopharyngeal cancer and blood selenium level.

A case-control study of nasopharyngeal carcinoma was performed in Zagreb from 1989 until 1993. Blood selenium concentrations were determined in 34 patients with nasopharyngeal cancer and 47 normal subjects by means of the atomic absorption spectrophotometric method. The sera of nasopharyngeal cancer patients showed no significant differences in selenium values from the sera of normal individuals, but there were significant differences between patients with enlarged cancer (T4 stage) and normal individuals. The results suggest that lower blood selenium levels in this group of nasopharyngeal cancer patients may be a consequence of their disease, rather than the cause of the cancer.

[Summating potentials in the differential diagnosis of cochlear pathology]. / Sumarni potencijali u diferencijalnoj dijagnostici kohlearne patologije.

Three groups of patients with Ménière's disease, sensorineural hearing loss caused by acoustic trauma, and healthy controls were examined by electrocochleography in order to establish the value of absolute summating potential (SP) amplitudes in the differential diagnosis of these entities. A statistically significant increase in absolute SP amplitudes was found in patients with Ménière's disease in comparison to patients with sensorineural hearing loss caused by acoustic trauma (p < 0.01). Besides that, there was also a statistically significant increase in absolute SP amplitude values in healthy persons, as compared to patients with sensorineural hearing loss caused by acoustic trauma (p < 0.05).

[Auditory evoked potentials in alcoholics]. / Slusni evocirani potencijali kod alkoholicara.

In this paper, auditory brain stem potentials in the group of 26 alcoholics were studied and a significantly delayed latencies of the peaks II through V as compared to the healthy control subjects were found. In addition, a statistically significant prolongation of brain stem transmission time (BTT) in alcoholics was observed. The study also suggests the possibility of monitoring the level of pathohistological changes of the central auditory pathway caused by excessive alcohol consumption.

[Oncocytic lesions of the larynx]. / Onkocitna lezija grkljana.

Oncocytic lesions of the larynx are considered particularly rare. Different names for these lesions have been used as a result of various theories concerning their biologic nature which is still controversial. Most investigators interpret these lesions as oncocytic metaplasias of the mucous gland cells in the larynx connected with senile involution of the upper respiratory tract with or without hyperplasia rather than true neoplasias. They are benign lesions, comprising 0.5 to 1% of all laryngeal mucosal changes, with a tendency to multifocal involvement occurring in patients over 50 years of age. Surgical excision is the treatment of choice. A case is reported.

Measurement of blood flow through AV-fistulae by means of Doppler sonography in regularly haemodialysed patients.

In regularly dialyzed patients a variety of pathological events can negatively influence haemodynamics and blood flow through arterio-venous fistula, leading to inadequate blood flow through the dialyzer or disturbances in hemodynamics of the whole body. It therefore appears important to quantify flow velocity and volume flow through the arteriovenous fistula in such cases. We used a Vasoview computer controlled system for noninvasive vascular diagnostics based on B-scan "real-time" ultrasound for imaging the structure of tissue, combined with pulsed Doppler ultrasound for determination of hemodynamics. Thirty patients (16 males and 14 females, aged 45 +/- 10 years; range 23 to 61 years), with different periods spent on hemodialysis (5.5 +/- 3.1 years, range 1 to 11 years) were included in this study. The average systolic, diastolic and mean blood volume flows were 2131.8 +/- 565.8, 972.0 +/- 309.6 and 728.4 +/- 287.4 ml/min, respectively. The mean blood volume flow was calculated by integration of the area under curve of blood flow in one heart cycle on the Doppler signal. It is calculated by the apparatus and displayed on the screen during measurement. The average blood vessel diameter was 9.1 +/- 1.3 mm (mu +/- omega). The results revealed a marked inter-individual variation in volume flow through arteriovenous fistulae of dialyzed uremics (range 240.0 to 1200.0 ml/min). Doppler ultrasound thus appears to be a valuable method for determination of blood flow through arteriovenous fistula of dialyzed uremics as well as for detection of hemodynamics disturbances of interest, such as turbulent blood flow.