Mirna Juretić

Mediastinitis and bilateral pleural empyema caused by an odontogenic infection

Mediastinitis and bilateral pleural empyema caused by an odontogenic infection Background. Although odontogenic infections are relatively frequent in the general population, intrathoracic dissemination is a rare complication. Acute purulent mediastinitis, known as descending necrotizing mediastinitis (DNM), causes high mortality rate, even up to 40%, despite high efficacy of antibiotic therapy and surgical interventions. In rare cases, unilateral or bilateral pleural empyema develops as a complication of DNM. Case report. This case report presents the treatment of a young, previously healthy patient with mediastinitis and bilateral pleural empyema caused by an odontogenic infection. After a neck and pharynx re-incision, and as CT confirmed propagation of the abscess to the thorax, thoracotomy was performed followed by CT-controlled thoracic drainage with continued antibiotic therapy. The patient was cured, although the recognition of these complications was relatively delayed. Conclusions. Early diagnosis of DNM can save the patient, so if this severe complication is suspected, thoracic CT should be performed.

Prognostički značaj morfologije invazivne tumorske fronte u karcinomu pločastih stanica usne šupljine

Aim: To establish invasive tumor front grade (ITFG) in squamous cell carcinoma of the oral cavity (OCSCC), compare it with traditional histological grade and to investigate the prognostic value of both. Materials and methods: The whole tumor-tissue sections, stained with HE of 86 OCSCC cases were evaluated for the invasive tumor front grade and compared with the clinicopathological prognostic parameters such as pathological stage (pT stage), pathological lymph node stage (pN stage), clinical stage (TNM stage) and length of survival of patients. Tissue has been disposed at the Department of Maxillofacial Surgery, University Hospital Rijeka. Data of traditional histological grade were obtained from previous histological findings. Results: Traditional histological grade was not significantly associated with clinical parameters or survival of patients (P = 0.906). High ITFG was associated with positive lymph nodes (P = 0.006) and clinical stage of disease (P = 0.025), but not to pathological T stage (P = 0.086). In univariate analysis high ITFG was associated with shorter survival of patients (P = 0.001), and multivariate analysis showed it as the independent prognostic factor (P = 0.006). For individual parameters that determine ITFG like inflammatory infiltrate, way of invasion and degree of keratinization was also established statistically significant prognostic value in univariate (P < 0.001, P = 0.013, i.e., P = 0.009) and multivariate analysis. Conclusion: ITFG has greater prognostic value than the traditional histological grade. Determination of ITFG may help identify patients with a higher risk of disease recurrence after surgical removal of the tumor, which would use additional methods of treatment. Prognostički značaj morfologije invazivne tumorske fronte u karcinomu pločastih stanica usne šupljine

P-757 - Oral and oropharinegeal cancer and defence mechanisms

Biological mechanisms of tumor development are largely known, however influence of psychological factors in alcoholics with malignant tumor of the oral cavity and the oropharynx are mostly unexplored. The aim of the research was to examine early family relations and investigate differences in the use of defense mechanisms in alcohol dependent patients suffering from malignant tumor of the oral cavity and oropharynx compared to alcohol dependent persons without malignant tumors and healthy controls. The research included 51 alcohol dependent patients treated for malignant tumor of the oral cavity and oropharynx at the University Hospital Center Rijeka from 2005 to 2009. The control groups corresponded to the experimental group in age, sex and education level. The research used a general demographic questionnaire, the Mini International Neuropsychiatric Interview and the Revised Questionnaire of Life Style and Defense Mechanisms.The research groups showed significant differences in difficult childhood (p