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The estimated prevalence of extranodal non-Hodgkin lymphoma ranges from 10 to 35% of all cases; a finding in the larynx is extremely rare. We describe the case of a 77-year-old man who presented for evaluation of a 1-month history of minor swallowing difficulty, cough, and a foreign-body sensation in the throat. Fiberoptic endoscopy detected a tumor mass on the left aryepiglottic fold. Vocal fold mobility was normal. A biopsy specimen was obtained, and microscopic analysis revealed that the stratified squamous epithelium was partially eroded by abundant infiltrate that had occupied the entire submucosa. The submucosal infiltration consisted of lymphatic cells, including small, medium-sized, and large cells with an anaplastic appearance. On immunohistochemical analysis, the lymphoma cell population stained positive for CD3 and CD2, focally positive for CD56, and negative for CD4, CD5, and CD7. In addition, tumor cells expressed TIA-1, perforin, and granzyme B. A complete radiologic, pulmonologic, and hematologic workup found no other tumor. The patient underwent two cycles of chemotherapy followed by radiotherapy, and he experienced complete tumor regression. At the 1-year follow-up, findings on fiberoptic endoscopy of the larynx were normal, and positron-emission tomography found no evidence of a recurrence. The prognosis for this type of tumor is good when the diagnosis is made in the early phase of the disease. Long-term follow-up is advisable for the timely detection of possible local or distant recurrences, which are common.

The association between cigarette smoking and an increased risk of laryngeal carcinoma has been demonstrated in numerous studies. The aim of the present study was to assess the prevalence of smoking habit in patients with different laryngeal pathologies. The prevalence of cigarette smoking was compared between patients with laryngeal tumors and those with nonmalignant laryngeal lesions. Data on all patients with indications for direct microlaryngoscopy at the Clinic for Otorhinolaryngology of the University Hospital Center Split, during a five-year period were analyzed. The study included 562 patients with various laryngeal pathologies, divided into three groups as follows: group 1, benign lesions; group 2, precancerous lesions; and group 3, tumors. The majority of patients (82.92%) had a long history of smoking. The proportion of smokers was lowest in benign lesion group (72.13%), higher in precancerous lesion group (81.48%) and highest in malignant lesion group (97.14%). There was a statistically significant difference in the prevalence of cigarette smoking between patients with laryngeal tumors and those with benign or precancerous lesions (p < 0.001). The mean number of cigarettes per day was 20.54 +/- 14.80, and was lowest in benign lesion group (15.67 +/- 13.41) and highest in malignant lesion group (26.33 +/- 12.70). The mean length of smoking habit was 26.44 +/- 16.92 years, ranging from 19.57 +/- 16.03 years in benign lesion group to 35.20 +/- 12.12 years in malignant lesion group. Study results clearly pointed to the increased prevalence of laryngeal diseases in smokers, with a significant difference between patients with benign laryngeal lesions and those with laryngeal tumors.

Aim: To determine the prognostic value of cell cycle regulators cyclin D1 and p27 for papillary thyroid carcinomas., Methods: Analysis included 180 patients with papillary thyroid carcinoma who underwent surgery at Split University Hospital Center between 1999 and 2001. Clinical data were obtained from clinical charts and histopathology reports. Immunohistochemistry was performed on formalin-fixed, paraffin-embedded tissue by antibody p27 and cyclin D1. Quantification was based on the intensity and distribution of nuclear staining., Results: Univariate analysis showed that sex (P=0.019) and capsular invasion (P=0.010) were significant predictors of lymph node metastases, whereas age (P=0.96), histopathological variant (P=0.075), size (P=0.556) and multifocality (P=0.131) were not. Univariate analysis also showed that overexpression of cyclin D1 (P<0.001) and underexpression of p27 (P<0.001) predicted lymph node metastases in papillary thyroid carcinomas. There was a significant correlation between cyclin D1 (P=0.024) and p27 (P=0.029) expression in two prognostic groups of low and high risk. Low risk group was cyclin D1 negative and p27 positive, while high risk group was cyclin D1 positive and p27 negative. Multivariate analysis confirmed that sex (P=0.041), capsular invasion (P=0.027), and p27 (P<0.001) were strong independent predictors of lymph node metastases in the high-risk group., Conclusions: Immunohistochemical analysis of p27 expression may be a valuable tool for identifying risk of lymph node metastases and more aggressive behavior of papillary thyroid carcinoma.

Andrea et al. were the first to use contact endoscopy in the diagnosis of laryngeal disease, in 1995. This method enables in vivo microscopy of laryngeal mucosa. In the present study, comparison of contact endoscopy with frozen section histopathology was performed in 142 patients with various diseases of the larynx. Paraffin section histopathology diagnosed 70 benign lesions, 23 precancerous lesions and 49 malignant lesions. Frozen section histopathology showed a sensitivity of 89.8 per cent, a specificity of 98.9 per cent and an accuracy of 95.7 per cent (chi2 = 1.5; p = 0.18). Frozen histopathology diagnosed 45 malignant lesions, including one false positive and five false negative results. Contact endoscopy yielded a sensitivity of 79.59 per cent, a specificity of 100 per cent and an accuracy of 92.95 per cent (chi2 = 8.1; p = 0.002). All malignant lesions diagnosed by contact endoscopy were confirmed by histopathology; contact endoscopy failed to recognise malignant lesions in 10 patients. Contact endoscopy is preferable to frozen section histopathology as it is noninvasive, provides information on microscopic diagnosis and laryngeal lesion margins, and enables visualisation of the laryngeal mucosa microvasculature. The use of contact endoscopy along with frozen section histopathology improves diagnostic accuracy and allows for operative (or other) therapy to continue according to the results obtained.

Objective: To evaluate the value of cytologic examination in the diagnosis of laryngeal tumors., Study Design: A series of 100 patients with suspected tumorous lesions of the larynx were included in the study. The material for cytologic analysis was obtained by use of a modified instrument, that is, a slightly concave discoid knife, during direct microlaryngoscopy, followed by biopsy for paraffin and frozen section histopathology. The findings obtained by cytology and frozen section histopathology were compared with the findings of paraffin section histopathology., Results: Cytology showed an 83.9% sensitivity, 100% specificity and 90% accuracy compared with histopathologic findings (p < 0.05; chi2 = 7.7). Frozen section pathohistology vs. paraffin section histopathology showed an 80.6% sensitivity, 97.4% specificity and 87% accuracy (p < 0.05; chi2 = 8.1)., Conclusion: Cytologic examination showed higher accuracy compared to frozen section histopathology, also giving an insight into the type of laryngeal pathology in the case of precancerous lesions. The use of cytology and frozen section histopathology during direct microlaryngoscopy improves clinical diagnostic accuracy.

We report the case of an unusual penetrating injury of the temporal region of the head caused by knife. A long kitchen knife was protruding from the upper auricular area of the left temporal region of victims head. It cut through the posterosuperior part of the left auricula and remained fixed to the postauricular region. Brain computorized tomography (CT) scan revealed that the knife had reached deep into the petrous part of the temporal bone, and was directed toward the sulcus of the sigmoid sinus. There were no signs of intracranial bleeding. An otorhinolaryngologist and a neurosurgeon removed the knife in operating room, with the patient in general anesthesia. The audiogram obtained after 7 days of hospitalization showed left conductive hearing loss of 40 dB at frequencies up to 2 kHz, and of 90 dB above 2 kHz, probably due to hemotympanum caused by the operation. Control examinations performed 14 days and one month after discharge confirmed the patients complete recovery and no significant defects in his hearing or balance. We suggest multidisciplinary teamwork as a proper approach in the treatment of such injuries.

Muscular echinococcosis accounts for 0.5% to 5.4% of all hydatid disease cases, with very little data on the incidence of muscular echinococcosis of the head and neck. We report a unique case of primary echinococcosis of the right sternocleidomastoid muscle in a 56-year-old man. Preoperative assessment by ultrasound and fine needle aspiration did not point to echinococcosis. We suspected the right diagnosis intraoperatively and confirmed it postoperatively by pathohistology and serologic tests. Echinococcosis of the liver and the lungs was also excluded postoperatively. Combination of operative treatment and postoperative albendazole herapy in two 28-day cycles one month apart resulted in complete regression of the disease. Echinococcosis should be considered as differential diagnosis of a multicystic mass in neck, particularly if it is of longstanding duration. Serologic tests for echinococcosis should be included in differential diagnostic procedures for each multicystic formation on the neck, especially in endemic areas.

The clinical management and long-term outcome in lightning survivors with substantial ear damage treated at the Department of Otorhinolaryngology, University Hospital Split during the 1984-1999 period are reviewed. Results of clinical management and outcomes of lightning ear damage in 18 patients (mean age 35.3 +/- 5 years) were retrospectively analyzed. On admission, all patients complained of severe pain, tinnitus and hearing impairment. Otomicroscopy revealed tympanic membrane rupture in 12 patients. The active therapeutic approach included immediate otomicroscopy, aseptic aspiration toilet, and eversion of perforation edges. In all patients, the ruptures healed well, and restitution of the hearing function was achieved. Follow-up examination performed in 1999 (13.2 +/- 2.9 years later) in 11 patients (mean age 52.3 +/- 6.1 years) revealed an almost identical audiogram as on discharge from the hospital, however, neuropsychological testing revealed numerous sequelae. Tympanic injury caused by lightning should be actively treated. Lightning survivors require additional psychotherapeutic treatment.

During the 6-year period (January 1, 1993 to December 31, 1998) in the Laboratory for Dermatopathology of Department of Dermatovenereology in Clinical Hospital Split, 1616 basal cell carcinomas (BCC) of a total of 323 investigated specimens were diagnosed. The incident rate varies from 92 to 114 BCC per 100,000 inhabitants in the Split region. The sex ratio in material is 1.2:1 in favor of males. The frequence of BCC increases with the advanced age in both sexes with the peak in the age group from 70 to 79 years. The most frequent location in both sexes is the nose followed by cheeks and trunk. Statistic analysis showed a significantly higher occurrence of BCC in temporal region in the males and perioral region in the females; respectively. The solid variant is the most frequent followed by superficial multicentric and solid-adenoid. Pure variants are found in 83.1% specimens, and mixed variants in 16.9%. Solid and adenoid variants are the most frequent on the nose and cheeks. According to statistics cystic variant is significantly higher on the forehead, and morpheic variant on the nose. Superficial multicentric variant is statistically more frequent on the trunk than on other locations. All specimens were reexamined and histopathologic variants were obtained. Over 2000 data are comprised which is a sufficient examination sample. In programs such as SPSS, and Graph master ver 1.12, Win95, MO'97 (Word, Excel, Access) on Pentium II 200 MHz, floppy, 64 MB RAM, HDD 2.1 GB, CD x24, HP LJet 6L, a comprehensive analysis has been performed.

Polyuria with marked plasma sodium disturbance was present in 39 of 224 patients with isolated craniocerebral war injuries. Twenty-one of these 39 patients had hyponatremia (sodium level < 130 mmol/l) and polyuria. Eight of them (38%) died within 30 days after trauma. The remaining 18 patients developed classic diabetes insipidus syndrome, and 6 of them (33%) died of hypernatremia within 30 days after trauma. The mortality in both patients with hyponatremia and patients with diabetes insipidus was higher in those with greater disturbances of plasma sodium concentration with polyuria and those with lower Glasgow Coma Scale scores.

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.

The incidence of postoperative nausea and vomiting was studied in a prospective group of 94 women of child-bearing age (18-42 years), undergoing unilateral elective thyroid surgery. In a subgroup of 47 examinees the postoperative nausea and vomiting episodes were analyzed according to the time of surgery within their menstrual cycle: the highest occurrence was observed in the periovulatory and premenstrual periods (65.5% vs. 27.8%, p < 0.02). In the formal part of this study, 25 patients randomly received ondansetron (8 mg intravenous [i.v.]): they had significantly less postoperative nausea and vomiting than their 22 placebo controls (4 ml saline i.v.): 16.0% vs. 45.5% (p < 0.04). It is concluded that elective surgery in young and middle-aged female patients is best avoided premenstrually and in the middle of their cycle. In these very periods, however, ondansetron effectively reduces the incidence and intensity of postoperative nausea and vomiting by about 70%.

Introduction: A retrospective study on the occurrence of septic syndrome and septic shock, as well as multiorgan failure, in the wounded at the Split Clinical Hospital Intensive Care Unit (ICU)., Patients and Methods: From 1991 to 1995, 257 wounded persons were treated at the Split Clinical Hospital ICU. Criteria for septic syndrome included evident infection, body temperature > 38 degrees C or < 30.5 degrees C, leukocytosis or leukopenia, thrombocytopenia, as well as dysfunction of one organ. The criterion for septic shock was septic syndrome with hypotonia., Results: Fifteen patients with septic syndrome and 9 patients with septic shock were admitted and treated at the ICU. Septic syndrome developed in 17 patients and septic shock in 16 patients at the ICU. Acute respiratory distress syndrome developed in 16, renal insufficiency in 26, gastrointestinal disorders in 6, hepatic disorders in 4, hematologic disorders in 13, and central nervous system dysfunction in 17 patients. Twenty-eight percent of patients died in septic syndrome, and 74% died in septic shock., Conclusion: Septic syndrome and septic shock were the most common causes of death in wounded persons treated at Split Clinical Hospital ICU. At the earliest phase the main cause of death was refractory hypotension, and at the later stage the main cause of death was multiorgan failure.

In the Rama mobile war hospital, intravenous (i.v.) anaesthesia was used in 78 patients undergoing surgical procedures lasting 4-25 min. Boluses of thiopentone (Group 1), propofol (Group 2), propofol + alfentanyl (Group 3), and ketamine + midazolam (Group 4) were used. Induction of anaesthesia, resulted in a mean blood pressure decreased about 15%. Apnoea of more than 20 sec was observed in Group 3, but no naloxone was required. Recovery was rapid enabling patients to maintain their own airway. The use therefore of titrated anaesthetics in war is considered acceptable.