Half a century of the professional and scientific work in otorhinolaryngology.
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Croatia↗
Biomedical subjects
Z Krajina
Publications and source records attributed to Z Krajina.
Pilocarpine in the prevention of postirradiation xerostomia.
During radiation therapy to the head and neck region, salivary gland hypofunction commonly develops. The aim of our study was to evaluate whether the sialogogue pilocarpine given during radiation therapy may reduce the severity of xerostomia and salivary dysfunction. Our results showed the pilocarpine-treated group to have a lower frequency of oral symptoms during the treatment than the placebo-treated group. Although salivary flow decreased in all patients, the pilocarpine-treated group had smaller flow reductions. No drug effect was observed in the glands that were completely irradiated. Thus, pilocarpine appeared to stimulate salivary tissues outside the radiation field.
Double-Blind Method↗
Endothelin-secreting tumors and the idea of the pseudoectopic hormone secretion in tumors.
Ectopic hormone secretion in tumor cells is here described as an amplification of hormone production already present in normal, nonendocrine tumor-originated tissue. This idea is tested on the available data regarding endothelin-1 (ET-1) secreting tumors. The endothelins are ubiquitous regulatory peptides produced by various tissues. The precursor cells of many tumor types secrete endothelins. ET-1 protein expression was detected in situ in all tested prostate cancers as well as in normal prostate tissue. The majority of hepatocellular carcinomas produce ET-1, while ET-1 is secreted by the normal hepatic stellate cells. Human breast cancer cells produce immunoreactive ET-1. Similar data exist for pancreatic tissue, the thyroid and large bowel. We can conclude that tumor cells might sustain endothelin secretions already present in the normal tumor-originated tissue. The model that is presented of the pseudoectopic hormone secretion consists of relations between a few parameters. The proportion of hormone-secreting tumors (Th) among all tumors (T) of that organ depends on the amount of the hormone-secreting cells (Ch) among all cells (C) susceptible to malignant transformation. The corrective factor (k) was introduced in the expression Th/T=Ch/C*k, to represent specific conditions altering the malignant transformation probability for a certain normal hormone-secreting cell. In prostate, breast and colon, the kvalue is predicted to be approximately 1, suggesting that ET-1-secreting normal cells are not more prone to the malignant transformation than their neighbours. In liver and pancreas, the incidence of ET-1-secreting tumors outnumbers the proportions of normal ET-1-secreting cells (k values >1). In these organs, normal ET-1-secreting cells seem more likely to turn malignant in comparison to their neighbours, perhaps due to their function, position and exposition to oncogenic factors, or even due to their ET-1 secretion. There are similar data for thyroid and adrenal glands. No ET-1 secretion was reported in kidney neoplasms. Normal renal ET-1 secreting cells might be less prone to turn malignant than other renal cells. Unlse the normal lung tissue, small cell lung cancers often secrete adrenocorticotrophic hormone (ACTH). The pancreatic islet cells do not secrete gastrin, but their tumors often do. Constant k would exceed 1 in both cases. We speculate that these tumors might originate from a small subset of cells with the described feature. Tumor cells sometimes lack features of the normal tissue, as in the cases of the steroid receptor-negative breast cancer. These tumors might originate from the hypothetical subset of receptor-free breast cells. Benign breast epithelial cells lacking oestrogen receptors have been described in cases of megalomastia. These cells might be constituents of normal breasts or, perhaps, present only in cases of increased breast cancer risk.
Animals↗
Nasal polyps in children.
During the 1980-1995 period, 957 patients were admitted for nasal polyposis, 59 (6.2%) of them children. Results were analyzed with respect to localization of the polyps, allergy, histologic picture, bacteriologic tests, radiologic findings of paranasal sinuses, cytology of nasal mucosa, therapeutic approach, and tendency to relapse. Forty children (22 boys and 18 girls) were analyzed. Their mean age was 11.1 years. Unilateral polyposis was found in 29, and bilateral in 11 children. Antrochoanal polyps (ACP) were found in 30, bilateral nasal polyps in 5, polyps in maxillary sinus in 5, and allergy in 8 children. Inflammation of the maxillary sinus was present in 93% of children with ACP. Their correlation between ACP and inflammation in maxillary sinus suggested that edema of the sinus mucosa have led to protrusion through the ostium and formation of the nasal polyp.
Adolescent↗
The Zagreb method of partial laryngectomy: a retrospective study 1970-1986.
The Zagreb method of partial laryngectomy is an original method of laryngeal reconstruction following tumor extirpation using the sternohyoid muscle fascia. This material is distant from the immediate tumor site, resistant to infection, saliva and shrivelling, thus being very appropriate for covering major laryngeal defects. Statistical data analysis included clinical records from 1970, when the method was introduced at ENT Department, Zagreb School of Medicine, till 1986. During the study period, 574 patients were admitted for operative treatment of laryngeal carcinoma, and the partial method was employed in 350 (61%) of them. This percentage has generally remained unchanged to the present, because the use of fascia has extended the partial procedure applications and subsequent reconstruction. This has allowed a more extensive tumor excision without strictly following classical horizontal and vertical laryngectomy, with the additional use of so-called partial laryngectomy on demand. Records on the follow-up (5-20 years) after this type of surgery revealed an 87% survival rate (n = 304).
Croatia↗
A contribution to the etiopathogenesis of nasal polyps.
The first author studied nasal polyposis from the epidemiological, clinical, immunologic and histologic points of view. Based on the year-long studies, the authors have isolated three issue of common interest to rhinologists since ancient times, i.e. relationship between allergy and nasal polyposis, predilection sites of the origin of polyposis, and the development process underlying the genesis of polyps.
Humans↗
Histology of nasal polyps in various conditions.
At the Salata ENT Department in Zagreb, 28 patients with nasal polyps were examined in the 1992-1993 period. Results of histologic analysis of these nasal polyps are presented. In 10 cases, nasal polyps were histologically examined at three horizontal levels, and the rest by vertical section. The method of hemalaun eoisin and histochemical methods (PAS, Alcian, Mallory, Giemsa and orcein) were used to analyze the following parameters: epithelium, stroma, basement membrane, cell infiltrate and glands. Patients were grouped according to the presence or absence of allergy, relapse of polyps and age group ( < 40 and > 40 years of age). The lateral nasal wall mucosa served as control. Histologic picture of the polyps showed some differences related to allergy and other groups of polyposis. In conclusion, histologic study of polyps should not be taken as the only indicator of the etiology of polyposis but, supplemented with other examinations, as an evidence supporting the diagnosis.
Adolescent↗
Undifferentiated nasopharyngeal cancer (UCNT): current diagnostic and therapeutic aspects.
Undifferentiated carcinoma of the nasopharynx (UCNT) is a particular head and neck epidermoid lineage tumor related to the Epstein Barr Virus (EBV). It has geographically selective endemic epidemiologic features, without relation to external carcinogens. Its systemic agressiveness is the source of most disease-related demises, because radiotherapy achieves excellent local control and a significant percentage of cure in patients with exclusive locoregional disease. Difference in the staying systems currently in use, the recent changes in imaging and radiotherapy technology, and the lack of distinction between UCNT and squamous cell carcinoma (SCC) of the nasopharynx in Western literature reports make for some difficulty in therapeutic results evaluation when analyzing available literature. Its chemosensitivity is a relatively recent acknowledged fact, and its use in metastatic patients results in a high percentage of objective responses, many of long duration. Neoadjuvant cisplatin-based chemotherapy seems to be of benefit, but outstanding controversies in this regard will be soon answered through ongoing phase III trials. After a review of the current literature of all the above-mentioned aspects of this fascinating nosologic entity, our own experience, both in metastatic and locoregional disease patients is analyzed.
Adolescent↗
A history of development of otorhinolaryngology in Croatia.
The author gives a brief survey of the development of otorhinolaryngology as an independent surgical specialization. The clinics on Salata and Vinogradska Street have had an important role in the development of the profession and research within the field. They have given training to new specialists and reached the present level in the development of the profession. They have given their scientific contribution to international otorhinolaryngology, paving the way for future development of the field in Croatia.
Croatia↗
International cooperation in medicine through the eyes of a physician and scientist.
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Attitude of Health Personnel↗
Etiopathogenesis of nasal polyps.
An acute process is practically never the cause of polyps, for despite the reaction being hyperergic, it spreads through the entire circumference of the mucosa. In chronic noxa the infiltrates will not be diffusely distributed and may in certain places be too large to form protuberances in the mucosa by themselves. The essence of this chronic process is a further proliferation of the connective tissue, especially around the blood and lymph vessels. Chronic oedemas in the mucosa of the nose and the paranasal sinuses are transported through venous and lymphatic vessels towards the nasal meatus, more towards the middle one than the upper one. In this region not only are there lymphatic vessels, but here also lies the borderline between low and raised tissue pressure. That is the place where most nasal polyps appear. Respiratory allergy is much more frequent in recurrent nasal polyposis (78%) than in the group of patients with non-recurrent polyposis (18%). Through histochemical analysis of nasal polyps, eosinophils are found in both recurrent and non-recurrent polyps (74% and 44%, respectively), as well as in the nasal mucosa (32% vs. 15%) which is statistically significant.
Humans↗
Partial laryngectomy in transglottic carcinoma.
At the ENT Department of Zagreb University from 1973 to 1982 119 cases of transglottic carcinoma were treated. In the first group of 20 cases total laryngectomy was done. Five years later, ten of the patients treated had survived. Primary and secondary neck metastases were present in 6 cases, i.e. 30%. In the second group of 99 cases partial laryngectomy (vertical and combined) was done. Five years later 70 cases had survived, i.e. 70%. Primary and secondary neck metastases were present in 19 cases, i.e. 19%. In the partial laryngectomy the reconstruction was done by fascia sternohyoidea and partial resection of the cricoid and totally of the arythenoid in the cases where there was the indication. Postoperative irradiation was given in cases with neck metastases and where resection margin was inadequate.
Glottis↗
Implication of tumour antigens and immune complexes in laryngeal cancer.
In the last 3 years tumour antigens (TA) and immune complexes (IC) were examined in 33 respectively 83 patients with cancer of the larynx. These tests were repeated several times during treatment and during the checking period. Tumour antigens were prepared from squamous cell carcinoma of the larynx using a modification of the methods by Bloom et al. and Halliday. Immune complexes in the serum were determined by the polyethylene glycol (PEG) test. In some cases the sensitivity to antigen was changed during the observation period. Constantly elevated immune complexes speaks in favour of recurrence in most of our cases.
Antigen-Antibody Complex↗
Vertical partial laryngectomy on demand.
The author proposes the term 'vertical partial laryngectomy on demand' for all modifications of vertical laryngectomies (frontal, frontolateral, vertical and hemilaryngectomy). This term includes two conditions: the first is complete oncological removal of the tumour (proven by histological examination and with the use of magnification or the operating microscope during the operation); secondly, reconstruction of the laryngeal defect by various procedures. The author uses the sternohyoid fascia in vertical and frontolateral partial laryngectomies. From 120 operated cases, a five-year survival rate of 81 per cent was achieved. The fascia showed resistance to post-operative complications and irradiation.
Combined Modality Therapy↗
Cytostatic and immunologic treatment of head and neck tumors.
Advanced head and neck tumors have a very low survival rate when treated by classical methods of irradiation and surgery. This is why in the last ten years cytostatics and immunotherapy have been applied. Clinical experience speaks in favour of polychemotherapy in comparison to monochemotherapy. In head and neck tumors bleomycin, methotrexate, 5-fluorouracil, vincristine and cis-Platinum have been used most often. They can be applied as initial therapy, additional therapy after surgery and irradiation, and finally as palliative therapy. Present experiences have shown the best results with initial therapy in 2-3 cycles, before surgery and irradiation. Toxicity of cytostatics depends on the dose and the sensitivity of the patient. The interval between cycles is 2-3 weeks. According to clinical experience, active specific immunotherapy with tumor vaccine did not prove successful. The investigations have thus been directed towards the means which would mobilise the immunological forces of the organism and remove obstacles in reaction of cytotoxic drugs and tumor cells. Such biological response modifiers are interferon, hormone of the thymus, substances which increase, change or restore immunological reactivity, lymphocytes, tumor preventive agents, NK cells, lymphokines, monokines and allokines, plasmophoresis and indomethacin.
Antineoplastic Agents↗
The influence of palato-cranial base (basomaxillary) angle on the length of the caudal process of the nasal septum in man.
The authors investigated and defined the relationship between the length of the caudal process of the quadrangular lamina and the palato-cranial base (basomaxillary) angle. The length of the caudal process was measured by an indirect method during surgical exposure in 71 patients with nasal septum deformity. The usual cephalometric reference points were used to form the angle reference lines; the points were marked over X-rays and traced on transparent paper using the "against the light" technique. It was found that the caudal process was longer than 3 cm (range 3.1-4.2 cm, mean value 3.45, standard deviation 0.34) when there existed a palato-cranial base angle; contrary, it was always shorter than 3 cm (range 1.9-3.0 cm, mean value 2.40, standard deviation 0.33) when the reference lines were parallel. That means that the angulation between the reference lines assigning the angle predisposes a longer caudal process, making possible a backward growth of this cartilaginous baton, and therefore the occurrence of some particular types of septal deformities. Finally, the authors suggest another name for the palato-cranial base angle, i.e. the basomaxillary angle, because it is simpler, shorter and still clear enough.
Cephalometry↗
The influence of radiotherapy and chemotherapy on cerebral metastases.
A group of 110 patients (68 male and 42 female) with cerebral metastases, treated at the Institute of Clinical Oncology and Radiotherapy, Zagreb University School of Medicine, during the period 1978-1984, were included in the study. Most patients were aged 50-60 years. Out of 110 patients, 52 were treated by radiotherapy and 58 by radiotherapy plus chemotherapy. Metastases from the bronchus carcinoma, breast carcinoma, melanoma and gastrointestinal carcinoma were present in 59%, 21.8% and 4.6% of patients, respectively. In 1.8% metastases from hypernephroma and in 3.6% from other malignant tumors were observed. In 4.6% cases, the origin of metastases could not be identified. Fifty-two out of 110 patients were treated by radiotherapy alone. They received 3000 cGy in 8-10 fractions, to the whole brain, with two parallel opposed fields. Fifty-eight out of 110 patients treated with radiotherapy and chemotherapy were given the same radiotherapeutic treatment. Chemotherapeutically, they were treated with BCNU and CCNU with or without Vincristin in standard doses. In the group of 52 patients treated by radiotherapy alone the median survival was six months (1-16 months), i.e. the same as in the group treated by both radiotherapy and chemotherapy (1-26 months).
Brain Neoplasms↗
[Radiotherapy in carcinoma of the epipharynx].
In five year period (1977-1982) 38 patients were treated for the epipharyngeal cancer in Department for oncology and radiotherapy and Department of otolaryngology of Medical Faculty in Zagreb. Most of the patients were male (76%), between 40 and 70 years of age. In 23 (60%) the cancer was poorly differentiated, in 15 (40%) well differentiated. Most of the patients were in advanced stage (III and IV - 37 patients, only one in I stage). All patients were primary treated by radiotherapy (telecobalt). The applied dose was 60 Gy in 50% of the patients. The other received lower doses (ten of them less than 55 Gy), only one received 70 Gy by classic fractions. Surgery was performed for residual neck nodes (radical neck dissection). Adjuvant chemotherapy was administrated as a rule in cases of poorly differentiated squamous carcinoma, as well as in all cases with local recurrence and/or distant metastases. Two years survival was 45%, three years 42% and five years 21%. The other radiotherapy techniques are discussed concerning the treatment improvement and diminishment of irradiation sequalae.
Adolescent↗