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OBJECTIVES/HYPOTHESIS: To investigate epidemiological features and symptoms of sialolithiasis and their implications for diagnosis and management. STUDY DESIGN: Retrospective cohort study. METHODS: Retrospective analysis on 2,322 patients with sialolithiasis, between 1987 and 2009. The statistical significance between two sample distributions was computed using analysis of variance Student t test for two-tailed distribution. RESULTS: A total of 2,959 calculi were identified by means of ultrasound. Of those, 80.4% were located in the submandibular duct system (53% hilar/proximal, 37% distal, 10% intraparenchymal) and 19.6% were parotid stones (83% in Stensen's duct, 17% intraparenchymal). Sialoliths had been discovered beforehand in the submandibular gland (P = 0.00024; t test). Symptoms, measured from first visit, lasted on average 26 months (range: 1 day-30 years). The main group suffered from swelling (50.3%), followed by painful swelling (41.6%) and pain (3.1%). Multiple stones were found in 16.9% of patients (18.1% in the submandibular gland; 14.3% in the parotid). Average stone diameter in the submandibular gland was 8.3 mm (range 1-35 mm), and the stones were in Lustmann group II (46%). In the parotid gland, the average diameter was 6.4 mm (range 1-31 mm), and 51% were in Lustmann group I. CONCLUSION: Nowadays, epidemiologic features and clinical manifestations of sialolithiasis play an important role, assisting not only in diagnosis but also in determining appropriate treatment. Due to their location and smaller diameter, parotid stones in some cases can only be treated using a mini-invasive endoscopic technique. Submandibular stones more often require a combined approach. LEVEL OF EVIDENCE: 4
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Endoscopía/métodos , Cálculos de las Glándulas Salivales/epidemiología , Adolescente , Adulto , Niño , Preescolar , Manejo de la Enfermedad , Femenino , Estudios de Seguimiento , Alemania/epidemiología , Humanos , Incidencia , Lactante , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Cálculos de las Glándulas Salivales/diagnóstico , Cálculos de las Glándulas Salivales/terapia , Adulto JovenRESUMEN
The goal of this retrospective study is the evaluation of pectoralis major myocutaneous pedicle flap (PMMPF) reliability in clinical practice based on the analysis of the leading indication and postoperative complications. In the period from 2005 to 2011 at the University Department of Otorhinolaryngology and Head and Neck Surgery, Zagreb University Hospital Center, a total number of 27 PMMPF were used in the treatment of 26 patients. Indications for flap use were upper aerodigestive tract and soft tissue defects following resection of head and neck cancer. One-stage reconstructive technique was used in all patients. Basic demographic data, clinical stage of malignant disease, indications, postoperative complications and management of flap-related complications were systematically analyzed. In 24 cases (89%) leading indication for flap use was primary defect reconstruction following head and neck carcinoma resection and in 3 cases (11%) "salvage" reconstruction following salivary fistula formation and flap-related complications. Tumor invaded skin in 2 (8%) cases, oral cavity in 1 (4%) case, oropharynx in 12 (46%) cases, larynx and/or hypopharynx in 10 (38%) cases and major salivary gland in 1 case (4%). Mucous defect occurred in 21 (81%), cutaneous defect in 3 (11%) and muco-cutaneous defect in 2 patients (8%), respectively. 16 postoperative complications (59.3%) were recorded but only one patient (4%) sustained total flap necrosis. Previously irradiated patients had significantly higher postoperative complication rate. The rate of complications requiring surgical treatment was 25%. Although the overall complication rate was substantially high, PMMPF achieved desired reconstructive goal in 96% cases. Functional and aesthetic assessment was difficult due to the small series of patients. In conclusion, pectoralis major myocutaneous pedicle flap is still safe and acceptable reconstructive method in surgical treatment of patients with head and neck tumors.
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Neoplasias de Cabeza y Cuello/cirugía , Músculos Pectorales/cirugía , Procedimientos de Cirugía Plástica , Colgajos Quirúrgicos , Humanos , Estudios RetrospectivosRESUMEN
The objective of this study is to evaluate the efficacy of the Harmonic ACE, Harmonic FOCUS and harmonic scalpel with 5-mm curved blade in head and neck surgery. During a 15-month period, we performed 295 thyroidectomies, 23 parotidectomies and 45 tonsillectomies using the harmonic scalpel. Control group consisted of 106 thyroidectomies, 9 parotidectomies and 30 tonsillectomies performed with the use of conventional hemostatic techniques. The use of both Harmonic ACE and Harmonic FOCUS scalpel reduced the time of thyroid and parotid surgery by 20-25%. The use of Harmonic ACE reduced the mean time of tonsillectomy, while the use of 5-mm curved blade had no significant effect. Postoperative pain and complication rate were comparable for both the groups. In conclusion, the use of both Harmonic ACE and Harmonic FOCUS devices significantly reduces operative time in the head and neck procedures and enables a smaller neck skin incision in thyroidectomy.
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Hemostasis Quirúrgica/instrumentación , Paratiroidectomía/instrumentación , Tiroidectomía/instrumentación , Tonsilectomía/instrumentación , Ultrasonido , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Diseño de Equipo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Instrumentos Quirúrgicos , Resultado del Tratamiento , Adulto JovenRESUMEN
As bibliographical classification of published journal items affects the denominator in this equation, we investigated how the numerator and denominator of the impact factor (IF) equation were generated for representative journals in two categories of the Journal Citation Reports (JCR). We performed a full text search of the 1st-ranked journal in 2004 JCR category "Medicine, General and Internal" (New England Journal of Medicine, NEJM, IF = 38.570) and 61st-ranked journal (Croatian Medical Journal, CMJ, IF = 0.690), 1st-ranked journal in category "Multidisciplinary Sciences" (Nature, IF = 32.182) and journal with a relative rank of CMJ (Anais da Academia Brasileira de Ciencias, AABC, IF = 0.435). Large journals published more items categorized by Web of Science (WoS) as non-research items (editorial material, letters, news, book reviews, bibliographical items, or corrections): 63% out of total 5,193 items in Nature and 81% out of 3,540 items in NEJM, compared with 31% out of 283 items in CMJ and only 2 (2%) out of 126 items in AABC. Some items classified by WoS as non-original contained original research data (9.5% in Nature, 7.2% in NEJM, 13.7% in CMJ and none in AABC). These items received a significant number of citations: 6.9% of total citations in Nature, 14.7% in NEJM and 18.5% in CMJ. IF decreased for all journals when only items presenting original research and citations to them were used for IF calculation. Regardless of the journal's size or discipline, publication of non-original research and its classification by the bibliographical database have an effect on both numerator and denominator of the IF equation.