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1. The Impact of Nutrition on the Onset, Course of Disease and Quality of Life of Patients with Laryngopharyngeal Reflux

Author

Tin Prpić, Melita Peček Prpić, Tihana Mendeš, Anamarija Šestak, and Andrijana Včeva

Subjects
laryngopharyngeal reflux, food with low reflux potential, quality of life, dietary habits, Biotechnology, TP248.13-248.65, Food processing and manufacture, TP368-456
Abstract

Research background. The role of dietary habits of patients with laryngopharyngeal reflux (LPR) is comparatively underexplored. The aim of the study is to examine dietary habits, onset and course of the disease as well as the quality of life of patients with LPR. Experimental approach. The results of the modified food frequency questionnaire (FFQ-m) and laryngopharyngeal reflux health-related quality of life (LPR-HRQL) questionnaires were compared between subjects with and without LPR. There were a total of 100 subjects with LPR and 65 subjects in the control group. The group of subjects with LPR was further randomly divided into two subgroups; the first subgroup was treated with esomeprazole at a dose of 20 mg twice daily combined with the instructions for dietary and general lifestyle changes, and the other with pantoprazole at a dose of 20 mg twice daily combined with the instructions for dietary and general lifestyle changes. Participants were instructed to fill out FFQ-m and LPR-HRQL questionnaires immediately after the initial examination and then after control examinations 30 and 60 days after the initial examination. Results and conclusions. Patients with LPR consume more food with high reflux potential, drink more carbonated drinks and juices and have a worse quality of life than the control group (p

Published
2023
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2. Laryngopharyngeal reflux: news in diagnostics and treatment

Author

Andrijana Včeva, ihana Mendeš, Anamarija Šestak, eljko Zubčić, Hrvoje Mihalj, Željko Kotromanović, osip Maleš, Tin Prpić, Ivan Abičić, Matej Rezo, Vjeran Bogović, Stjepan Grga Milanković, Željko Vranješ, Ljiljana Širić, and Tamara Kopf

Subjects
laryngopharyngeal reflux – diagnosis, etiology, therapy, symptom assessment – methods, pepsin a, bile acids and salts, life style, feeding behavior, diet therapy, proton pump inhibitors – therapapeutic use, Medicine (General), R5-920
Abstract

In the last fifty years, globalization and urbanization have significantly changed our lifestyles and our eating habits. We live hectic lifestyles and are exposed to many stressful situations every day, we consume readymade, quickly prepared food, carbonated and alcoholic beverages. All of this is accompanied by the food industry, which also acidifies all the foods to prolong their shelflife. As a consequence of bad eating habits, consuming food when you should rest, stress, but also the activities of the food industry, there has been an epidemic of reflux disease. Part of this disease is laryngopharyngeal reflux, a disease characterized by the return of gastric contents to the throat and surrounding organs, which leads to hoarseness, coughing, swallowing and breathing difficulty, and ultimately the development of benign and / or malignant changes in the larynx. In most patients, pepsin plays a key role in developing changes in the larynx and other organs, and its acidic medium serves to maintain proteolytic activity. In addition to pepsin, bile acid salts and other gastroduodenal proteins may play a role in the development of inflammatory changes in the mucosa of the upper aerodigestive tract. In most cases, we start laryngopharyngeal reflux therapy with medication, however this is wrong and ineffective. Therefore, it is important to emphasize that treatment must always begin with a change in diet, lifestyle and stress regulation. The treatment of laryngopharyngeal reflux must be individual and should involve a multidisciplinary team with a nutritionist, a psychologist and a psychiatrist.

Published
2022
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3. Successful Repositioning Procedure for Benign Paroxysmal Positional Vertigo after Stapedotomy

Author

Željko Zubčić, Andrijana Včeva, Tihana Mendeš, Josip Maleš, Hrvoje Mihalj, Hrvoje Vidić, Matej Rezo, Ivan Abičić, Tin Prpić, and Anamarija Šestak

Subjects
Rehabilitation, Balance Disorders, Benign Paroxysmal Positional Vertigo, Otosclerosis, Vitamin D Deficiency, Medicine
Abstract

This report aimed to investigate the relationship after successful left‐sided stapedotomy and postoperative benign paroxysmal positional vertigo (BPPV) due to vitamin D deficiency. A 56‐year‐old woman presented with a complaint of progressive hearing loss and tinnitus in the left ear without dizziness. A successful left‐sided stapedotomy was performed, confirming the diagnosis of otosclerosis and closing the air‐bone gap to less than 10 dB. Seven days after the stapedotomy, the patient reported dizziness, usually when turning to her left side in the bed. An electrophysiological assessment was performed to investigate vestibular function. Dix Hallpike maneuver showed a typical response, about 5 seconds after repositioning the head, and geotropic, torsional rotary nystagmus of about 30 seconds was registered. Vitamin D deficiency in serum was found. Complete symptom remission was achieved after 7-day-treatment with Epley’s maneuver. As a postoperative vertigo complication, BPPV often remains unrecognized after stapes surgery. Canalith repositioning maneuver is treatment for BPPV. Determining serum levels of total calcium and vitamin D may play a significant role in monitoring and reducing the recurrence of dizziness.

Published
2022
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4. Implementation of Telemedicine in Otorhinolaryngology

Author

Hrvoje Mihalj, Željko Zubčić, Andrijana Včeva, Željko Vranješ, Josip Maleš, Darija Birtić, Tihana Mendeš, Stjepan Grga Milanković, Tin Prpić, Vjeran Bogović, Ivan Abičić, Matej Rezo, Miroslav Moguš, and Anamarija Šestak

Subjects
telemedicine, otolaryngology, distance counseling, Medicine
Abstract

Telemedicine is a term that covers all procedures supported by communication technology, which has the purpose of providing health services at a specific spatial distance. This is an area that is developing rapidly and has found particular application in otorhinolaryngology, given that a large number of surgeries are performed with the help of endoscopes and microscopes. Telemedicine also represents a significant advantage during the coronavirus pandemic, both in terms of treating patients and monitoring them more effectively. For the purpose of preparing this article, research published on Scopus, PubMed, Google Scholar, and Google was reviewed using the keywords “telemedicine” and “otorhinolaryngology”. This review article provides a summary and the latest insights in this broad and fast-growing area. The development of telemedicine in Croatia as well as a special review of the application of telemedicine during the coronavirus pandemic is also presented in this article.

Published
2021
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5. Characteristics of Malignant Thyroid Tumors: A Retrospective Study on 320 Patients

Author

Ivan Abičić, Tin Prpić, Vjeran Bogović, Stjepan Grga Milanković, Hrvoje Mihalj, Andrijana Včeva, Željko Zubčić, Anamarija Šestak, and Matej Rezo

Subjects
thyroid cancer, tumor size, extrathyroidal invasion, multifocality, lymphovascular invasion, Medicine
Abstract

Papillary thyroid cancer accounts for 80-85% of diagnosed thyroid cancers, while follicular, medullary, and anaplastic cancers are diagnosed significantly less frequently. This study aimed to show the characteristics of malignant thyroid tumors. In this retrospective study, we analyzed data from 320 patients who underwent thyroid surgery from January 2018 to December 2019. We recorded and statistically analyzed basic demographic data, data of the cytological and pathohistological findings, and tumor characteristics (size, multifocality, extrathyroidal and lymphovascular invasion). Thyroid cancer was diagnosed in 95 patients. The incidence of thyroid cancer was higher in women than in men, but without a significant difference (p=0.46). There was a significant difference between preoperative cytological findings and definitive pathohistological diagnosis (p=0.001). There was no significant difference between genders in tumor size, extrathyroidal and lymphovascular invasion, and multifocality. There were significantly more thyroid cancers with a lymphovascular invasion that were less than 2 cm in size (p=0.04). In our opinion, it is important to emphasize the value of early diagnostics and analysis of the malignant tumor characteristics that are major prognostic factors for survival in patients with thyroid cancer.

Published
2020
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6. The Association Between Type 2 Diabetes Mellitus, Hypothyroidism, and Thyroid Cancer

Author

Željko Zubčić, Anamarija Šestak, Hrvoje Mihalj, Željko Kotromanović, Andrijana Včeva, Tin Prpić, Matej Rezo, Stjepan Grga Milanković, Vjeran Bogović, and Ivan Abičić

Subjects
type 2 diabetes mellitus, hypothyroidism, thyroid cancer, Medicine
Abstract

This study aimed to investigate the association between type 2 diabetes mellitus (T2DM), antidiabetic therapy, hypothyroidism, and thyroid cancer. We analyzed data from 320 patients who underwent thyroid surgery for suspicion of cancer. The diagnosis of thyroid cancer was confirmed by histopathological analysis in 95 patients. No significant difference was found in the diagnosis of T2DM and hypothyroidism concerning the presence of thyroid cancer (p=0.13; p=0.85), nor in the gender of patients with T2DM and hypothyroidism with respect to the type of thyroid cancer (p=0.19; p=0.25). Patients with T2DM (Odds ratio [OR] 1.89; 95% CI, 0.856-4.163) and patients with hypothyroidism (OR, 1.05; 95% CI, 0.530-2.164) had higher prevalence of thyroid cancer, as did those who had both diagnoses combined (p=0.37; OR, 2.39; 95% CI, 0.333-17.278), compared with the patients who did not have those diagnoses. Men with T2DM (OR, 6.19; 95% CI, 1.180-32.513) had higher prevalence of thyroid cancer than women. Patients who were on oral antidiabetics (OR, 1.91; 95% CI, 0.804-4.512) had higher prevalence of thyroid cancer than those receiving insulin. According to the results of this study, we can conclude that there is an association between T2DM, hypothyroidism, oral antidiabetics, and thyroid cancer.

Published
2020
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7. Characteristics of Malignant Thyroid Tumors: A Retrospective Study on 320 Patients

Author

Matej Rezo, Hrvoje Mihalj, Stjepan Grga Milanković, Anamarija Šestak, Ivan Abičić, Tin Prpić, Vjeran Bogović, Željko Zubčić, and Andrijana Včeva

Subjects
Male, medicine.medical_specialty, endocrine system, Medullary cavity, Lymphovascular invasion, lymphovascular invasion, lcsh:Medicine, Gastroenterology, extrathyroidal invasion, Papillary thyroid cancer, Internal medicine, Professional Papers, Follicular phase, medicine, thyroid cancer, Humans, Thyroid Neoplasms, Thyroid cancer, Retrospective Studies, business.industry, Incidence (epidemiology), tumor size, Thyroid, lcsh:R, Retrospective cohort study, General Medicine, multifocality, medicine.disease, Carcinoma, Papillary, thyroid cancer, tumor size, extrathyroidal invasion, multifocality, lymphovascular invasion, medicine.anatomical_structure, Thyroid Cancer, Papillary, Thyroidectomy, Female, business
Abstract

SUMMARY Papillary thyroid cancer accounts for 80-85% of diagnosed thyroid cancers, while follicular, medullary, and anaplastic cancers are diagnosed significantly less frequently. This study aimed to show the characteristics of malignant thyroid tumors. In this retrospective study, we analyzed data from 320 patients who underwent thyroid surgery from January 2018 to December 2019. We recorded and statistically analyzed basic demographic data, data of the cytological and pathohistological findings, and tumor characteristics (size, multifocality, extrathyroidal and lymphovascular invasion). Thyroid cancer was diagnosed in 95 patients. The incidence of thyroid cancer was higher in women than in men, but without a significant difference (p=0.46). There was a significant difference between preoperative cytological findings and definitive pathohistological diagnosis (p=0.001). There was no significant difference between genders in tumor size, extrathyroidal and lymphovascular invasion, and multifocality. There were significantly more thyroid cancers with a lymphovascular invasion that were less than 2 cm in size (p=0.04). In our opinion, it is important to emphasize the value of early diagnostics and analysis of the malignant tumor characteristics that are major prognostic factors for survival in patients with thyroid cancer.

Published
2020

8. The effectiveness of diode laser in reduction of inferior turbinate

Author

Ivan Abičić, Stjepan Grga Milanković, Anamarija Šestak, Hrvoje Mihalj, Vjeran Bogović, Željko Zubčić, Andrijana Včeva, Matej Rezo, and Tin Prpić

Subjects
Reduction (complexity), Materials science, business.industry, law, Optoelectronics, General Medicine, business, Laser, Diode, law.invention
Published
2020
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9. Primjena telemedicine u laringologiji

Author

Hrvoje Mihalj, Željko Zubčić, Andrijana Včeva, Željko Kotromanović, Željko Vranješ, Josip Maleš, Darija Birtić, Tihana Mendeš, Stjepan Grga Milanković, Tin Prpić, Vjeran Bogović, Ivan Abičić, Matej Rezo, Miroslav Moguš, and Anamarija Šestak

Subjects
telemedicina, laringologija, 5G, COVID-19
Abstract

Telemedicina je pojam koji obuhvaća sve postupke podržane komunikacijskom tehnologijom čiji je cilj pružanje zdravstvenih usluga na određenoj prostornoj udaljenosti. To je područje koje se brzo razvija i pronašlo je posebnu primjenu u laringologiji. Razvoj telemedicine u laringologiji predstavlja novi pristup dijagnostičkim i terapijskim postupcima, posebno razvojem 5G tehnologije. Najvažnije što nam donosi primjena 5G tehnologije je brz i pouzdan prijenos podataka, izuzetno niska latencija, te pokrivenost i energetska učinkovitost potrebna za takav prijenos podataka. Ovo je jedno od brzo razvijajućih područja koje zasigurno uvodi novinu u svakodnevnu praksu, poboljšava kvalitetu i dostupnost medicinske njege u područjima u kojima nedostaje liječnika. Jedna od najranijih primjena telemedicine u laringologiji bilo je provođenje glasovne rehabilitacije, dok se do danas uvelike proširila primjena. Primjena telekirurgije je pravi primjer razvoja tehnologije i njezine primjene u medicini. Telemedicina je također značajna prednost tijekom pandemije COVID-19 virusom, kako za liječenje bolesnika, tako i za njihovo učinkovitije praćenje, kao i za bolju komunikaciju između stručnjaka. Svakako treba naglasiti nedostatke telemedicinske tehnologije, a to je prije svega skupa oprema, potreba za dodatnom obukom osoblja, limitiran fizikalni pregled i nemogućnost liječenja određenih stanja i bolesti. U zemljama poput Hrvatske, gdje su resursi ograničeni, telemedicina ima najveću prednost u situacijama kao što su pandemija COVID-19 virusom, kao i u obrazovne svrhe.

Published
2021

10. Tortikolis kao primarna prezentacija retrofaringealnog apscesa u djece

Author

Tin Prpić and Hrvoje Mihalj

Subjects
tortikolis, retrofaringealni apsces, oteklina vrata
Abstract

Uvod: Retrofaringealni apsces je vrlo rijedak oblik duboke infekcije vrata koji se nerijetko primarno prezentira kao tortikolis. Svrha ovoga prikaza slučaja je da se naglasi važnost uzimanja u obzir retrofaringealnoga apscesa u djece kao diferencijalne dijagnoze prilikom nastanka spontanog tortikolisa, te naglašavanje spoznaje da odgađanje operativnog zahvata u takvim slučajevima može dovesti do fatalnih komplikacija. Prikaz slučaja: Petogodišnje dijete se javlja u hitnu traumatološku ambulantu zbog otežanog gutanja krute hrane, oticanja vrata, tortikolisa i anamneze pada na glavu prije nekoliko dana. Učini se RTG snimka vratne kralježnice, gdje se verificira obilni retrofaringealni apsces. Dijete je upućeno od strane traumatologa u hitnu otorinolaringološku ambulantu, gdje se verificiraju visoki upalni laboratorijski parametri. Prema heteroanamnestičkim podacima dan prije hitnog pregleda nije imalo prisutnu oteklinu vrata i nije naginjalo glavu u stranu. U kliničkom statusu je bila prisutna manja oteklina lateralne desne strane orofarinksa, uz spontanu sekreciju gnojnoga sadržaja, a na desnoj strani vrata se palpiralo difuzno, tvrdo i elastično zadebljanje, bez jasno formirane otekline, uredne nadležeće kože. Učinio se CT vrata i toraksa na kojem se opisalo retrofaringealno od razine C2-C6 s protezanjem u područje paravertebralne muskulature desno, a kaudalno završavajući u razini štitnjače, heterodenzna opsežna zona dijelom cistična (nekrotična) koja odgovara retrofaringealnome apscesu. Ordinira se parenteralna antibiotska terapija (Ceftriakson 2x1 g iv. te Klindamicin 3x300 mg iv.). Indicira se hitan operacijski zahvat, te se učini incizija i drenaža parafaringealnog i retrofaringealnog apscesa vrata desno, te eksploracija vrata. Nakon operativnog zahvata dijete se smjesti u pedijatrijsku intenzivnu jedinicu, gdje se višednevno postoperativno prati poboljšanje kliničkoga statusa, te normaliziranje upalnih laboratorijskih parametara. Dijete se sedmi postoperativni dan, urednoga općega i lokalnoga stanja, otpusti na kućno liječenje. Zaključak: Možemo zaključiti da kod djece nakon traume s prisutnom oteklinom vrata i tortikolisom treba razmotriti mogućnost postojanja duboke infekcije vrata (retrofaringealnoga apscesa).

Published
2021

11. Duboke infekcije vrata

Author

Hrvoje Mihalj, Željko Zubčić, Andrijana Včeva, Željko Kotromanović, Tatjana Rotim, Nives Zrno, Anamarija Šestak, Vjeran Bogović, Stjepan Grga Milanković, Tin Prpić, Ivan Abičić, and Matej Rezo

Subjects
duboka infekcija vrata, apsces, klinički značaj, dijagnoza, liječenje, duboka infekcija vrata, apsces, klinički značaj, dijagnoza, liječenje
Abstract

Duboke infekcije vrata su infekcije koje mogu obuhvatiti nekoliko vratnih prostora. Danas su rjeđe u odnosu na preantibiotsko doba, a najčešći uzroci su širenje infekcije od zuba, žlijezda slinovnica, krajnika, trauma ili je pak uzrok infekcije strano tijelo. Klinička slika često ne mora biti tipična, te dijagnostički postupak i liječenje ponekad predstavljaju izazov za kliničare, a od velikog su značaja zbog moguće brze progresije i razvoja životno ugrožavajućih komplikacija. Cilj ovih smjernica za kliničku praksu je pomoći liječnicima u ujednačavanju pristupa bolesnicima s dubokim infekcijama vrata. Opisani su relevantni uzroci, dijagnostički i terapijski postupak. One uzimaju u obzir dokaze iz više izvornih znanstvenih članaka iz dostupne medicinske literature, oslanjajući se pri tome na naše dugogodišnje iskustvo.

Published
2020

12. Usporedba endoskopske i standardne septoplastike

Author

Josip Maleš, Stjepan Grga Milanković, Anamarija Šestak, Vjeran Bogović, Ivan Abičić, and Tin Prpić

Subjects
septoplastika, endoskopska septoplastika, rinomanometrija
Abstract

Cilj rada: Cilj studije je usporediti endoskopsku i standardnu septoplastiku na temelju prijeoperacijske i postoperacijske simptomatologije i nalaza kompjuterizirane rinomanometrije. Materijali i metode: U prospektivnu studiju uključeno je ukupno 40 bolesnika koji su podijeljeni u dvije skupine. Prvu skupinu čini 20 bolesnika kojima je učinjena standardna septoplastika, a drugu čini 20 bolesnika kojima je učinjena endoskopska septoplastika. Postoperacijske kontrole provedene su 7., 14. i 30. dan. Rinomanometrija je učinjena na kompjuteriziranom rinomanometru. Sve septoplastike su učinili iskusni specijalisti. Rezultati: Kod 80% bolesnika kojima je učinjena standardna septoplastika došlo je do subjektivnog poboljšanja disanja na nos, te u 95% bolesnika kojima je učinjena endoskopska septoplastika. Simptomi glavobolje i postanazalne sekrecije su nestali kod 50% i 70% bolesnika kojima je učinjena standardna septoplastika, te kod 80% i 85 % bolesnika kojima je učinjena endoskopska septoplastika. Značajno su više vrijednosti protoka zraka i manje vrijednosti otpora na rinomanometrijskom nalazu poslijeoperacijski kod bolesnika kojima je učinjena endoskopska septoplastika u odnosu na prvu skupinu. Zaključak: Endoskopska septoplastika je metoda izbora za različite deformitete septuma, prvenstveno izoliranih spina, krista, te devijacija posteriornog dijela septuma. Ova tehnika pruža bolju vizualizaciju u odnosu na standardnu septoplastiku, a time je i manja šansa od komplikacija, te je korisna metoda edukacije. Endoskopska septoplastika limitirana je znatnom subluksacijom septuma.

Published
2020

13. Unilateralna endoskopska septoplastika

Author

Josip Maleš, Stjepan Grga Milanković, Vjeran Bogović, Anamarija Šestak, Tin Prpić, and Ivan Abičić

Subjects
endoskopska septoplastika, septoplastika, deformacije septuma
Abstract

Cilj rada: Endoskopska septoplastika je noviji i alternativni pristup korekciji deformirane nosne pregrade. Cilj rada je opisati operativnu tehniku i prednosti unilateralne endoskopske septoplastike u usporedbi sa standardnom septoplastikom. Preduvjet za ovakvu septoplastiku je jednostrana deformacija septuma, te medioponiranost septuma u kolumeli. Materijali i metode: Retrospektivno su analizirani podaci 20 bolesnika kojima je učinjena unilateralna endoskopska septoplastika u razdoblju od siječnja 2019. do prosinca 2019. godine. Prije početka operacijskoga zahvata učinjena je standardna priprema. Za vizualizaciju je korišten rigidni endoskop. Skalpelom br. 15 se učini horizontalna incizija mukoze koja prati deformitet, te se incizija produži ispred samog deformiteta pod 90°. Raspatorijem se preparira perihondrij i periost, te se deformirani dio septuma odstrani skalpelom i dlijetom, nakon čega sluznica pokrije defekt poput zavjese. Postavi se silikonska udlaga, te jednostrana prednja tamponada. Rezultati: Kod 65% bolesnika bila je prisutna unilateralna krista u arei ll, lll i IV (po Mladini), a kod 35% bolesnika bila je prisutna unilateralna krista ili spina u arei IV i V. Kod 95% bolesnika zabilježeno je subjektivno poboljšanje disanja, te nisu zabilježene komplikacije u smislu krvarenja, lezije sluznice, hematoma, perforacije septuma i nepotpune korekcije deformiteta. Zaključak: Unilateralna endoskopska septoplastika je minimalno invazivna tehnika za korekciju deformiteta nosne pregrade tipa izoliranih spina i krista, te pruža izvrsnu vizualizaciju, uz vrlo malu mogućnost komplikacija. Ova tehnika je indicirana isključivo kod jednostranih deformacija septuma.

Published
2020

14. Smjernice za opstruktivnu apneju u spavanju

Author

Andrijana Včeva, Davorin Đanić, Ana Đanić Hadžibegović, Boris Šimunjak, Boris Filipović, Hrvoje Mihalj, Željko Zubčić, Tihana Mendeš, Željko Kotromanović, Željko Vranješ, Josip Maleš, Željka Roje, Stjepan Jurić, Anamarija Šestak, Vjeran Bogović, Stjepan Grga Milanković, Tin Prpić, Ivan Abičić, Matej Rezo, Andrijana Včeva, Davorin Đanić, Ana Đanić Hadžibegović, Boris Šimunjak, Boris Filipović, Hrvoje Mihalj, Željko Zubčić, Tihana Mendeš, Željko Kotromanović, Željko Vranješ, Josip Maleš, Željka Roje, Stjepan Jurić, Anamarija Šestak, Vjeran Bogović, Stjepan Grga Milanković, Tin Prpić, Ivan Abičić, and Matej Rezo

Abstract

Poremećaji disanja tijekom spavanja vrlo su česti i u odraslih i u djece. Opstruktivna apneja u spavanju (OSA) najčešći je poremećaj disanja tijekom spavanja i ozbiljan javnozdravstveni problem. OSA je kronična bolest udružena s kardiovaskularnim i metaboličkim poremećajima. Prevalencija OSA kreće se između 2% i 4% u odrasloj populaciji. Dijagnoza OSA postavlja se cjelonoćnom polisomnografijom ili kardiorespi-racijskom poligrafijom a endoskopskim pregledom gornjeg dišnog puta za vrijeme medikamentozno induciranog spavanja (eng. drug induced sleep endoscopy – DISE). Određujemo mjesto, težinu i konfiguraciju opstrukcije. Na temelju dobivenih nalaza moguće je planirati individualnu konzervativnu i kiruršku terapiju.

Published
2020

15. Efikasnost redukcije donjih nosnih školjki diodnim laserom

Author

Hrvoje Mihalj, Andrijana Včeva, Željko Zubčić, Anamarija Šestan, Stjepan Grga Milanković, Tin Prpić, Ivan Abičić, Matej Rezo, Hrvoje Mihalj, Andrijana Včeva, Željko Zubčić, Anamarija Šestan, Stjepan Grga Milanković, Tin Prpić, Ivan Abičić, and Matej Rezo

Abstract

Uvod: Hipertrofija donjih nosnih školjki koja je refraktorna na konzervativnu terapiju je jedan od najčešćih problematika u rinologiji. Redukcija donjih nosnih školjki s diodnim laserom je minimalno invazivna i sigurna metoda koja se može provesti u lokalnoj anesteziji. Cilj rada je prikazati efikasnost redukcije donjih nosnih školjki diodnim laserom na temelju subjek- tivnih simptoma nazalne opstrukcije, nazalne sekrecije, glavobolje i smanjenog osjeta mirisa, te nalaza rinomanometrije. Materijali i metode: U studiju je uključeno 62 pacijenta kojima je učinjena redukcija donjih nosnih školjki diodnim laserom u razdoblju od studenog 2017. godine do prosinca 2019. godine. Postoperativno kontrole su provedene sedmi dan i mjesec dana nakon operacije. Svim pacijentima je učinjena rinomanometrija na kompjuteriziranom rinomanometru prije i nakon operacije. Rezultati: Kod svih pacijenata je bila prisutna nazalna opstrukcija prijeoperativno. Kod 50 % pacije- nata je bila prisutna nazalna sekrecija prijeoperativno, kod 22,5 % glavobolja, te u 16,1% slučajeva pacijenti su slabije osjetili mirise. Mjesec dana postoperativno 88% pacijenata se više nije žalio na nazalnu opstrukciju, a 83,8% na nazalnu sekreciju. Kod 6,5% pacijenata je i dalje perzistirao simp- tom glavobolje, te 4,8% pacijenata se i dalje žalio na smanjen osjet mirisa. Značajno su manje vrijednosti ukupnog otpora zraka na rinomanometrijskom nalazu postoperativno (p<0,001). Kod jednog pacijenta su uočene sinehije kao postoperativna komplikacija. Zaključak: Upotreba diodnog lasera u redukciji donjih nosnih školjki je sigurna, efektivna metoda s minimalno komplikacija i kratkim periodom oporavka pacijenata, te se može provesti u lokalnoj anesteziji., Introduction: Inferior turbinate hypertrophy that is refractory to conservative therapy is one of the most common problems in rhinology. Reduction of the inferior turbinate with a diode laser is a minimally invasive and safe method that can be performed under local anesthesia. The aim of this study is to show the efficiency of diode laser in reduction of inferior turbinate based on symptoms of nasal obstruction, nasal secretion, headache, hyposmia, and rhinomanometry findings before and after surgery. Materials and Methods: A total of 62 patients were included in this study, who underwent diode laser turbinate reduction between November 2017 and December 2019. Patients were followed up after seven days and one month after surgery. Rhinomanometry was performed before and after surgery. Results: Nasal obstruction was present in all patients before surgery, nasal secretion in 50% of patients, headache in 22.5%, and hyposmia in 16.1% of patients before surgery. One month after surgery, 88% of patients no longer complained of nasal obstruction and 83.8% of nasal secretion. In 6.5% of patients the symptom of headache persisted and 4.8% of patients continued to complain of decreased sense of smell. Total nasal resistance was significantly lower after surgery (p <0.001). Synechiae were observed in one patient as a postoperative complication. Conclusions: Reduction of inferior turbinate with diode laser is a safe, effective method with minimal complications and a short patient recovery period, and can be performed under local anesthesia.

Published
2020

16. EFFECTIVENESS OF UNILATERAL PEDICLE SCREW FIXATION IN TRANSFORAMINAL LUMBAR INTERBODY FUSION (TLIF)

Author

Tin Prpić

Subjects
Surgical Treatment, TLIF, unilateral transpedicular fixation, VAS pain scale, operativno liječenje, unilateralna transpedikularna fiksacija, VAS skala
Abstract

Uvod: Cilj je rada utvrditi uspješnost operacijskog zahvata transforaminalne discektomije i ugradnje CAGE-a (TLIF), te unilateralne fiksacije i kontralateralne posteromedijalne spondilodeze, uspoređivanjem kliničke slike prije učinjenog operacijskog zahvata i nakon njega. Uspješnost je definirana smanjenje intenziteta boli u križima i nogama pomoću VAS skale prije i poslije operacijskog zahvata, te postojanjem urastanja na radiološkim snimkama. Istraživanje je ustrojeno kao retrospektivno-prospektivna studija. Uključeno je 32 pacijenta, od toga 20 žena i 12 muškaraca. Metode: Za potrebe istraživanja koristili su se podatci iz povijesti bolesti pacijenata prikupljeni iz medicinske dokumentacije Zavoda za ortopediju KBC-a Osijek. Ti podatci koristili su se za procjenu uspješnosti liječenja diskogene boli kirurškom metodom transforaminalne discektomije i ugradnje CAGE-a (TLIF), te unilateralne fiksacije i kontralateralne posteromedijalne spondilodeze. Analizirani su podatci: spol, dob, uzrok diskogene boli, nivo fiksacije, procjena boli VAS skalom u križima i nogama prije i poslije operacije, učinjenost fuzije, prisutnost pareze peronealnog živca. Rezultati: Medijan dobi ispitanika u vrijeme operacijskog zahvata bio je 58 godina. Najčešći uzrok bolesti je diskogena bol kod 17/32 ispitanika. Najčešći nivo fiksacije je L4-L5 kod 16/32 ispitanika. Fuzija je učinjena kod 27/32 ispitanika. Pareza peronealnog živca je prisutna kod 3/32 ispitanika. Razlike u bolovima u križima i nogama prije i poslije operacije statistički su značajne i svjedoče o uspješnosti operativnog zahvata. Zaključak: Liječenjem diskogene boli metodom transforaminalne discektomije i ugradnje CAGE-a (TLIF), te unilateralne fiksacije i kontralateralne posteromedijalne spondilodeze postiže se značajno smanjenje boli., Introduction: The aim of this study was to evaluate the success rate of transforaminal lumbar interbody fusion (TLIF) with unilateral pedicle screw fixation and contralateral posteromedial fusion by comparing clinical features before and after the surgical procedure. Success rate was defined by a reduction in pain intensity in the lumbar region and legs using the VAS scale before and after the procedure. Fusion was evidenced on standard X-ray of lumbar spine. The study was set up as a retrospective-prospective study. It included 32 patients, 20 of whom were women, and 12 men. Methods: Data from medical history obtained from medical records of the Department of Orthopaedic Surgery, University Hospital Center Osijek, was used for research purposes. The collected data was used to evaluate the success of surgical method of TLIF with unilateral pedicle screw fixation and contralateral posteromedial fusion. The analyzed data included gender, age, etiology of the disease, spine level for fixation, pain evaluation in the lumbar region and legs using VAS scale before and after surgery, fusion and paresis of the peroneal nerve. Results: The median age of patients at the time of surgery was 58 years. The most common etiology of the disease is discogenic pain in 17/32 participants. The most common spine level for fixation is L4-L5 in 16/32 participants. Fusion was accomplished in 27/32 participants. 3/32 participants had experienced paresis of the peroneal nerve. The difference in pain intensity in the lumbar region and legs before and after the procedure was statistically singnificant and it supports the efficiency of the procedure. Conclusion: A significant reduction of pain was achieved in the treatment of discogenic pain with TLIF with unilateral pedicle screw fixation and contralateral posteromedial fusion.

Published
2018

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