Vladimir Djordjevic

Clinical characteristics of the eardrum retraction pocket

Development of the eardrum retraction pocket, as pathologic finding, depends on Eustachian tube dysfunction, onset of the middle ear infection and site of development of retraction on the eardrum. The study is aimed at: 1. Determining the incidence of eardrum retraction pocket and cholesteatoma within it, as well as at the degree of eardrum retraction; 2. Determining of association between eardrum retraction pocket and changes of the eardrum mucosaand parstensa of the tympanic membrane; 3. Determining of onset and intensity of the bone destruction in eardrum retraction pocket; 4. Examining of Eustachian tube function based on time of mucocilliary transport according to the type of the eardrum retraction pocket. The study is based on the retrospective analysis of the results obtained from the patients treated at the Institute of Oto-Rhino-Laryngology and Maxillofacial Surgery Clinical Centre of Serbia in Belgrade for the diagnosis of the chronic suppurative otitis who underwent otosurgical procedures during the six-year period, from 1996-2001. In our series of 540 patients subjected to otosurgical treatment, the incidence of the retraction pocket of the eardrum was 11.23%. Onset of more severe degree of eardrum retraction was most frequent in the attic. Cholesteatoma was detected in 82.2% of patients of the group with the attic-retraction pocket of the eardrum, as well as in 25% of patients of the group of tensa-sinus retraction pocket of the eardrum. Atrophic changes of the tympanic membrane pars tensa were detected in almost all tensa-sinus retraction pockets of the eardrum. Approximately one half of the attic-retraction pockets of the eardrum were accompanied by eardrum atrophy. Bone destruction of the auditory ossicles was limited to the long process of incus and superior structures of stapes. Time of the mucocilliary transport was significantly longer (p<0.01) in attic-retraction pocket of the eardrum than in tensa-sinus retraction pocket of the eardrum, indicating significance of tube in development of attic-retraction pocket of the tympanic membrane. Reversible changes of the middle ear mucosa were evidenced in three quarters of the tensa-sinus retraction pockets of the eardrum indicating that inflammation is the major factor influencing onset of tensa-sinus retraction pocket of the eardrum.

Prospective case–control study of efficacy of bilateral selective neck dissection in primary surgical treatment of supraglottic laryngeal cancers with clinically negative cervical findings (N0)

To evaluate the efficacy of bilateral selective neck dissection of levels II–IV in elective and therapeutic management of the neck as a part of primary surgical treatment of patients with supraglottic laryngeal cancer and clinically negative cervical findings (N0).

Late complication of the frontobasal trauma.

AbstractThe injuries of the frontobasal region are always a great challenge to a surgeon, especially the management of bone defects of the frontal region. The authors present a patient with late, 33-year postaccident complication, which had been surgically treated, and whose frontal bone defect had been reconstructed with methyl methacrylate. Clinical examination and computed tomography confirmed signs of previous operation and presence of an infection and alloplastic material. Specific for this case was challenge to manage chronic infection and reestablish integrity of the scull in the frontal region. Out of a variety of autogenous or alloplastic materials, and considering the extent of bone defect and previous episodes of treatment aimed at aesthetic and functional results with good prognosis, we opted for reconstruction of the frontal region defect with combined titanium mesh impregnated with the hydroxyapatite cement.

European Organization for Research and Treatment of Cancer Quality of Life Questionnaire–Head and Neck Module, updated version: Preliminary psychometric data from Serbian laryngectomized patients

We provided preliminary psychometric data for the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire–Head and Neck Module, updated version (QLQ‐H&N43) from a group of Serbian laryngectomized patients.

Etiopathogenetic aspects of recurrent cholesteatoma development

Abstract The causes of cholesteatoma development have been interpreted in different ways. The object of our study was to present the most frequent causes of recurring cholesteatomas on the basis of our investigations. The prospective study carried out at the Institute for Otorhinolaryngology and Maxillofacial Surgery included 120 patients treated surgically for cholesteatomas. Seventy-five patients were cured after the first operation, while 45 were reoperated after recurrent cholesteatoma. The modified student t test was used to establish the difference between statistically significant groups (small independent sample proportion). The cholesteatoma was often localized in attic (25.3%) and was spreading into antrum (28%). Another group of cholesteatoma was more frequently present in mesotympanum. The small marginal perforations in back quadrants were noted more frequently in the second group (26.7%). Likewise, 40% of the patients from this group had intact chain of auditory ossicles. Destruction of all three auditory ossicles was more often in the first group. Polypoid mucosa was less detected in the first group (18.7%) in relation to the second group (46.7%). Canal wall-up tympanoplasty was used more commonly in the second group of patients. In patients treated surgically for cholesteatoma, the recurrence of the condition may be caused by different factors such as development of cholesteatoma in posterior parts of cavum, polypoid mucosa, localization of cholesteatoma in meso- and retrotympanum and obscured cavity recesses, intact chain of auditory ossicles and the application of close tympanoplasty.

Actinomycotic hepatic abscess in woman with longstanding intrauterine contraceptive device

We present a case of a 50 year-old female bearing an intrauterine contraceptive device for 20 years who was diagnosed with abdominopelvic actinomycosis with liver dissemination. The patient was successfully treated by a combination of surgical resection and a 3-month course of amoxicillin.

Early rehabilitation of patients after inguinal lymphadenectomy for carcinoma of the penis

Early rehabilitation of patients after inguinal lymphadenectomy for cancer of the penis is important in order to decrease morbidity and mortality. Half of patients with cancer of the penis are subjected to the inguinal lymphadenectomy, which has a high rate of morbidity and mortality. Out of 30 patients who underwent lymphadenectomy on Clinic for urology, Clinical center of Serbia, 10 received radical lymphadenectomy. Morbidity rate was 42%, and mortality rate was 10%. Other 20 patients underwent modified lymphadenctomy. Morbidity rate was 20%, while mortality rate was 0%. Kinesitherapy on the first postoperative day: breathing exercises, peripheral circulation exercises, chest massage with Wick with training of coughing and expectoration, exercise to preserve muscle strength and range of motion for upper and lower extremities, inhalation, elastic stockings on the lower extremities, along with gradual mobilization, sitting on the edge of the bed, get up and walk with assistance (all with a belt). Successful and early physiotherapy is necessary for quick recovery of operated patients, enabling their fast return to normal life and saving time and resources for the treatment of complications.

Extended supraglottic laryngectomies

In the period 1976-1998, 408 patients with supraglottic laryngeal cancer were primarily treated by surgery using the method of supraglottic laryngectomy. Classical supraglottic laryngectomy was performed in 355 patients, while 53 underwent extended supraglottic laryngectomy. The objective of the study was to analyze the success of the extended supraglottic laryngectomy in relation to classical supraglottic laryngectomy in indicated cases. T1 tumor was found in 171 (42%) patients, T2 in 212 (52%), while T3 was found in 25 (6%) cases. Local recurrence developed in 3 out of 53 patients operated by the extended supraglottic laryngectomy technique, and in 17 out of 355 operated by classical supraglottic laryngectomy (chi2=0.075, DF=1, p=0.784; Yates=0.00, p=1.00). Five-year survival of patients operated by the extended supraglottic laryngectomy was reported in 40 out of 53 patients, while survival of patients operated by classical supraglottic laryngectomy was noted in 270 out of 355 cases (chi2=0.004, DF=1, p=0.926; Yates=0.00, p=1.00). There was no significant difference of local recurrence and five-year survival between patients treated by classical and extended supraglottic laryngectomy.