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Biomedical subjects

P Stanković

Publications and source records attributed to P Stanković.

At least 19 recordsLinked to original sources
PubMed2004

[Dilemmas and controversies related to cancers of the anterior laryngeal commissure].

From diagnostic and therapeutical aspect, the cancers of the anterior laryngeal commissure are the separate category in glottic cancers. But, they have not been individually classified in the majority of statistical reports, and, therefore, the incidence of the anterior commissural cancer should be taken with precaution. The issue of therapeutical strategy is controversial, considering the options and limitations of resections of the anterior commissural tumors, within the conception of oncological radicalism. Dilemmas are being especially faced with in radiotherapy, given the failures and unsatisfactory radiotherapeutical results. The prospective clinical study included the analysis of the incidence of primary and secondary cancers of the anterior commissure of the larynx. The follow-up of five-year survivals allowed for the establishment of efficiency of the applied therapeutical methods. The results of five-year survival in patients treated by primary surgery were highly more significant in relation to results obtained by radiotherapy of patients.

Carcinoma↗
PubMed2004

[Onco-surgical significance of anatomo-morphological specificity of glottic region of the larynx].

Glottis is a medium level of the larynx, involving the vocal cords, vocal process of arytenoid cartilage, and the anterior and posterior commissures. This region of heterogeneous histomorphological structure has specific characteristics: the internal striated muscles, the outer and inner perichondrium, atypical intra-cartilaginous areas of ossification, and unusual muscular insertion to cartilage. Microtomy of 3 thick successive sections was performed at the level of the upper surface of vocal cords. Standard histological staining methods were used. Microphotographs were taken by light microscope under different magnification along with histomorphometric measurements. Cancer spread is partially restricted by anatomic barriers: vocal ligament and tendon of the anterior commissure, and subsequently by the elastic cone. Easier tumor extension may be due to absence of the internal perichondrium and ossification of thyroid cartilage. Microvascularization of the anterior commissure is significant for tumor spread in glottis and paraglottic space. The role of commissural lymph network in local spread of the cancer is completely vague. It is certain that there are causes, still unrecognized, which have an effect on the pathways and direction of malignant tumor spread.

Adult↗
PubMed2004

[Extended supra glottic 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.

Carcinoma, Squamous Cell↗
PubMed2004

[Surgery treatment of laryngeal carcinoma T1].

The early stage cancer of the glottis, including Tis, T1a and T1b stages, are the most common forms with the incidence rates ranging from 25% to 85%. The therapy of early glottic cancer is usually successful for two reasons. First, true glottic cancer produces early symptoms and it is relatively easy to remove. Second, glottis is rather poor with lymph pathways so the regional metastases are rare, less than 1%. Due to role of the larynx in phonation, respiration and swallowing, the cancer of this region and its treatment has a great impact to the quality of life. Retrospective study involved ten-year period, from January 1990 to January 2004. At the Institute for Otorhinolaryngology and Maxillofacial Surgery, Clinical Center of Serbia, 858 surgical and 54 endoscopic CO2 laser-assisted resections were performed for glottic cancers of larynx of Tis-T2 stages. Glottic tumors were treated by Types III, IV and Va chordectomies according to classificaiton of endoscopic chordectomy defined by the European Laryngological Society. Analyzing the operated patients, as well as the type of the applied surgery, that is, endoscopic-laser and classic surgery, the authors attempted to clarify the dilemmas relating to the indications for one or another type of surgical intervention. The patients who had undergone primary radiotherapy were excluded from the analysis.

Adult↗
PubMed2004

[Radical surgery of the malignant laryngeal tumors].

Modern therapeutical protocols for treatment of T3 and T4 malignomas of the larynx are not adjusted, because there are attempts to treat these diseases with non-operative methods (such as chemo- and radiotherapy) in order to preserve the organ. The aim of the study was to establish today's results of the surgical treatement of patients with T3 and T4 laryngeal malignoma. We studied the group of patients with laryngeal carcinoma, who had undergone total laryngectomy, during the period of eight years (1990-1997). The patients' data was submitted from medical documentation, it was filled in specially designed questionnaries and was statistically reviewed. During this eight-year-period, 1054 total laryngectomies were done. The five-years survival rate, established in the group of patients who had undergone total laryngectomiy is 308/794 (39%). In the patient group where total laryngectomy was salvage surgery after radiotherapy, the five-years survival rate is 47/172 (27%). In the patient group where total laryngectomy was salvage surgery after conservative or reconstructive surgery, the five-years survival rate is 28/84 (33%). Despite diagnostical and therapeutical achievements, prognosis for T3 and T4 malygnoma of the larynx was not significantly approved in the last few decades.

Adult↗
PubMed2004

[Effect of the extents of surgical resection in total laryngectomy on esophageal voice and speech rehabilitation].

The study of functional results of total laryngectomy cannot be separated from articulation of esophageal voice and speech. To achieve success of phoniatric rehabilitation in laringectomized patients, it is necessary to be well aware of pathological sequelae of the very operation, long-term adverse effect of oncological risk factors as well as postoperative anatomo-physiological changes. Anatomic results of total laryngectomy depend on the type of surgical intervention and probable radiotherapy. The extent of surgical procedure, primary dictated by oncological indications, has the essential effect to articulation of esophageal voice and speech. If possible for oncological reasons, hyoid bone should be particularly left intact. Extensive surgical interventions of hypopharynx and the base of the tongue during laryngectomy, neck dissection--especially the radical one, and subsequent radiotherapy, all of them significantly reduce the possibility to produce esophageal voice and speech. Total laryngectomy eliminates the creator of voice and vibrations, which are acoustically perceived as esophageal voice, proceeding at the level of pharyngoesophageal junction. For this reason, the quality of newly created vibrating narrowing is especially important.

Adult↗
PubMed2004

[The analysis of the quality of life in laryngectomized patients].

Total laryngectomy, as extremely mutilating surgical intervention, results in drastic changes of the style and quality of life. The trauma of laryngectomy is huge, both to patients and their environment. The most pronounced changes of the quality of life of laryngectomized patients are seen at marital, familial, professional, business and communication aspects. Malignant disease and total laryngectomy significantly reduce working capacity, producing, besides professional, the economical difficulties. Psychological implications associated with total laryngectomy are the most severe, comprehensive ones and require multidisciplinary approach. The study analyzes the frequency and distribution of factors affecting the quality of life of laryngectomized patients (sex, age, psychic status, probable history of chronic diseases, impairment of hearing and social-family environment of patients). Significant improvement of the quality of life of laryngectomized patients is achieved by systemic, planned and multidisciplinary rehabilitation of patients as well as their immediate environment. The need for the association of laryngectomized patients is stressed.

Adult↗
PubMed2004

[Classification of chronic inflammation of the upper respiratory tract based on allergy status].

Almost one third to one half of all patients in otorhinolaryngologic practice experience some kind of inflammation of the upper respiratory tract out of which allergic mechanisms, either as primary factors or secondary ones, appear in 30-40% of adults and 60-80% of children and adolescents. The objective of this study was to analyse inflammatory conditions of the upper airways on the basis of allergic state of the patient and to establish the classification that will respect the actual immunological alteration level (subclinical allergy, clinical allergy) and spreading (localized allergy, generalized allergy). Inclusion criteria for all sixty nine patients were the diagnosis of chronic upper airway inflammation and their exposition just to ubiquitous allergens. Diagnostic procedure included anamnesis, physical examination and allergic in vivo testing of the skin and nasal mucosa to inhalant allergens. The certain categories of results were established for the skin prick-test (positive, negative, indefinite), specific nasal provocation test (positive, negative, hyperreactive) and nasal symptoms (present, absent). By using a strictly determined combination of results, we were able to define the six groups in our classification: nasal clinical allergy (30% of patients), non-nasal clinical allergy (19% of patients), localized nasal allergy (11% of patients), latent allergy (3% of patient), nonspecific nasal hyperreactivity (12% of patient) and non-allergic inflammation (25% of patients). Our classification takes into consideration the modern knowledge in the field of allergology and may bring an additional quality in respect to selection of therapy options, long-term follow-up of allergy status evolution in the individual person as well as intragroup and intergroup analysis of parameters important to evaluate the effects of antiallergic prevention or therapy.

Adolescent↗
PubMed2004

[Surgery of cholesteatoma: surgical technique and cholesteatoma recurrences].

Past experience with open and closed techniques of tympanoplasty in surgery of cholesteatoma has shown that recurring illness is one of the major causes of surgical failure. The literature has reported varying trend of surgical treatment of cholesteatoma. The objective of the study was to analyze the significance of surgical technique in relation to the incidence and most frequent localization of recurrent cholesteatoma. Our study analyzed 120 patients operated on for cholesteatoma. The patients were divided into two groups, group I (45) with recurring disease and group II (75) without any recurring condition, which were followed up three years. Statistical analysis was carried out by modified t-test. The largest number of patients was re-operated in the first two years from the initial surgery (50%), In the majority of patients (50%), recurrent cholesteatoma was most commonly localized (stage I) in attic (20%) and much rarely in mesotympanum (11.9%). Stage III recurrent cholesteatoma was verified in 35% of patients, most frequently diffuse form (13.4%). The involvement of attic by all three stages of disease accounted for over 60%. The analysis of the used techniques of surgical treatment in both groups revealed significant difference. Open techniques of tympanoplasty were used in 60% of patients with no recurrence. Closed techniques were used more frequently in patients with recurring disease, i.e. in over 90% of cases. Recurerrent cholesteatoma develops, in the majority of cases, during the first two years after the surgical intervention. Attic is the most common localization of cholesteatoma. More frequent utilization of open technique of tympanoplasty for surgery of cholesteatoma significantly reduces the incidence of recurring condition. The indications for CWD technique are the initial spread of cholesteatoma, possibility of complete removal of cholesteatoma and postoperative follow-up of patients.

Cholesteatoma, Middle Ear↗
PubMed2002

[Treatment of bites to the hand and wrist--is the primary antibiotic prophylaxis necessary?].

Animal bites make up a large proportion of the injuries treated in an emergency department. Due to the type of injury, the variety of wounds and the contamination with aerobic and anaerobic organisms, they deserve special attention. In this study, we reviewed 98 patients (55 male/43 female) with bite wounds to the hand and wrist treated between 1995 and 2000. They were either treated conservatively (n = 65) or surgically (n = 33) depending on the clinical findings. In 18 of 33 cases, the reason for surgical treatment was an infection. A primary antibiotic prophylaxis, usually with cephalosporines, was administered in 47 of 98 cases. Results were analysed retrospectively. An infection developed in 32 patients. In six of these patients, an infection developed despite primary antibiotic prophylaxis. Operative treatment became necessary in four of these six cases. Twenty-six of 32 patients were treated without primary antibiotic prophylaxis. Surgical treatment was required in around half (n = 14) of these patients, while the other 12 patients were treated conservatively with antibiotic therapy.Twenty-one of 26 patients presented with bite wounds that were already infected. Microbiological examination revealed a variety of microbes, usually a mixed infection with Pasteurella multocida was found. All organisms were susceptible to treatment with second or third generation cephalosporines.A total of 15 patients had to be operated due to deeper injuries to the bone, extensive soft-tissue injury, or because of injury to a tendon and the tendon sheath. In most patients, a good to acceptable functional result was achieved. Primary antibiotic prophylaxis does not prevent the development of infection. Nevertheless, because of the inherently high infection risk associated with bite wounds to the hand and wrist, prophylaxis should be carried out. In case of severe damage to the soft tissue or signs of infection, early surgical therapy should be considered.

Adolescent↗
PubMed2001

[Treatment of Galeazzi's fracture - is the surgical revision of the distal radioulnar joint necessary?].

PURPOSE: Fractures of the radial shaft associated with disruption of the distal radioulnar joint (DRUJ) are termed as Galeazzi-fractures. In Galeazzi's fracture, the aim of treatment is restoring the congruency of the joint and the stability of the DRUJ, thus preventing a loss of pronation or supination. PATIENTS AND METHOD: In this study, we included 24 patients (m = 22, f = 2) with 25 Galeazzi fractures treated between 1980 and 1998. Surgical treatment and the duration of therapy were analyzed retrospectively. The clinical and radiological results of 15 patients were followed up. Two children were treated conservatively with immobilization in an above-the-elbow plaster. 19 patients were treated surgically by rigid internal fixation with a plate approximately one week after the accident. Four patients were treated initially in a different way. In 13 cases, the distal radioulnar joint was immobilized by pinning with Kirschner wires. In ten patients, the DRUJ showed no instability. Patients with DRUJ pinning received an above the elbow plaster for six weeks, the other patients received a forearm cast for the time of wound healing. RESULTS: Two patients developed a pseudarthrosis following Kirschner-wire or rush-pin osteosynthesis. The consolidation of remaining fractures was regular. In two patients, the DRUJ was not completely stable after temporary fixation. The remaining patients revealed a stable DRUJ. Eight patients showed a limited pro- or supination after temporary Kirschner wire fixation of the DRUJ. The other patients did not reveal a decrease in range of motion. CONCLUSION: A stable and optimal reduction and a rigid internal osteosynthesis are requisites for healing of the radius fracture. Open reduction of the DRUJ is only indicated when soft tissue interposition prevents exact reposition. Surgical revision of the distal radioulnar joint was not necessary in our patients. Patients after Kirschner-wire fixation showed a diminished pro- or supination. To prevent Kirschner-wire failure, postoperative cast immobilization is indicated. Due to the retrospective nature of the study it is not definitely clear if Kirschner wire fixation is superior to immobilization.

Adolescent↗
PubMed1998

[Initial experiences with interposition of a silicon sheet in reconstruction of the wrist joint].

We report about the possibility to improve the condition of incongruent joint surfaces by temporary interposition of silicon sheet in the radiocarpal joint. The implant was used in 18 patients with damaged joint surfaces, either for the primary operation or for revision. It was removed four to six weeks after having started physiotherapy. Our results show that this procedure can improve the condition of joint surfaces. Silicon-induced granulation tissue can even uprough parts of the joint surface and thus reduce chondral friction. We did not see any complications.

Adolescent↗
PubMed1993

[Corrective interventions for malunited fractures of the distal end of the forearm. Indications, choice of procedure, results].

Malunion, non-union, as well as painful ligamentous joint instability following fractures to the distal forearm may seriously compromise the function of a hand. Forty-seven surgically treated cases, thirty-nine of which were followed up, are presented in order to point out the problems of such lesions. Retrospective evaluation of the lesion is absolutely mandatory, as it often dates back to childhood. Management should take clinical findings as well as the patient's functional demands on his hands into consideration, but without overestimating therapeutic potentials.

Adolescent↗
PubMed1993

[Experience with the Ender hooked plate in the management of 42 scaphoid pseudarthroses].

To treat the pseudarthrosis of scaphoid, there exist many operative procedures. We describe the method of H. G. Ender: A hook plate fixes the main bone fragments and exerts a pressure on the in-between lying bone transplant. We report on 42 patients operated on using the Ender-plate. In 39 cases a follow-up was possible. 95% of the patients had a consolidation of the bone, in two cases a further operation was required. 36 patients complained preoperatively of pain during exercise and only seven patients had the same complaints after the operation. In some cases, a minor reduction of the motion had to be taken into account to achieve painfree movement.

Adult↗
PubMed1992

[Results of angled plated osteosynthesis in per- and subtrochanteric fractures in the elderly].

From 1/86 to 12/89 62 old patients (average age: 82.6) with intertrochanteric and subtrochanteric fractures underwent surgery by using angeled plates. The postoperative course showed complications in 32.2%, while only 1 patient died. In 3 of 5 cases with dislocation of the angeled plate re-osteosynthesis was performed. 4 other complications (2x haematoma, 2x wound dehiscence) needed further surgery. During the first three months 3 other dislocations occurred. In two cases re-osteosynthesis was carried out. Due to these results and the high rate of complications we are of the opinion that the indication for the use of the angeled plate osteosynthesis in old patients has to be limited in favor of other methods like the dynamic hip screw or total hip replacement.

Aged↗
PubMed1991

Primary surgical treatment for carcinoma of the larynx: influence of the local invasion.

In the period from 1976 to 1988, 417 patients with supraglottic carcinoma of the larynx were treated by primary surgery. Infiltration of the pre-epiglottic space was found in 11.99 per cent (50/417) of the patients. Carcinomas of the infrahyoid epiglottis spread to this space more frequently--14.24 per cent (44/309), than those of suprahyoid localization--5.55 per cent (6/108). Tumour invasion of the pre-epiglottic space is a relative contra-indication for reconstructive surgery. Partial conservation operations were performed on 32 per cent (16/50) of patients with invasion of the pre-epiglottic space. The remaining patients had a total laryngectomy. Infiltration of the paraglottic space intra-operatively was found in 2.4 per cent (10/417) of patients and all of these tumours were from the infrahyoid localization. Spread of tumours to this site is an indication for radical surgery and laryngectomy was performed on 80 per cent (8/10) of patients.

Carcinoma↗
PubMed1991

[Sonographic assessment of gliding characteristics and gliding bed of the Achilles tendon following surgery].

A bilateral comparative ultrasound evaluation of 55 patients 1-10 years after unilateral Achilles tendon rupture showed that glide was reduced by varying degrees in the tendon in a dynamic evaluation. Disturbed tendon glide was often the cause of persistent disability. In the evaluation of the glide characteristics it was helpful to allocate patients to three categories, structural changes in the tendon bed also being taken into consideration. According to this classification, 56% of the Patients had either good or only slightly reduced glide characteristics, whilst 42% demonstrated severe reductions. It was striking that it was not so much alterations in the tendon itself, but rather changes in the tendon bed that had the more deleterious effects on glide characteristics.

Achilles Tendon↗