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.     

Pharmacotherapy for spondyloarthropathies

Since decade ago spondyloarthropathies (SpA) were neglected group of rheumatic disorders because of narrow therapeutic window. Main managing principles are described with emphasis to the assement of disease activity and distribution of pathological changes. Nonsteroidal antirheumatic drugs (NSAID) and physical therapy are still cornerstone for axial disease. Sulphasalzine and methotrexate are first choice considering peripheral arthritis. Biologic agents are effective in active vertebral and extravertebral disease. Local corticosteroid injection is favourable method for enthesitis and oligoarthritis and systemic treatment is indicated in patients during flare up of inflammation. Pamidronate and thalidomid are potential new agents for refractory cases.     

Classification and pathogenensis of spondyloarthropathies

The classification and pathogenesis of spondyloarthropathies are presented.     

Umbilical metastasis (Sister Mary Joseph's nodule) diagnosed by fine-needle aspiration

Sister Mary Joseph's nodule is the eponym for metastatic involvement of the umbilicus. This less common entity is the sign of disseminated malignant disease, mainly of digestive and gynecologic origin, and is associated with a poor prognosis. A case of Sister Mary Joseph's nodule in a 76-year-old woman in whom the umbilical metastasis was the first sign of malignant disease in presented. The diagnosis of metastatic adenocarcinoma was established by fine needle aspiration cytology of the umbilical nodule. Radiological and ultrasonographic investigation disclosed carcinoma of the gallbladder with pancreas, stomach, and colon invasion as well as peritoneal dissemination. The diagnosis was confirmed by exploratory laparatomy and histological examination of the excised umbilical nodule.     

Carbamazepine for acute psychosis with EEG abnormalities

AIM: To investigate the efficacy of carbamazepine as adjuvant drug therapy in acute paranoid psychosis with associated EEG abnormalities, compared to sole antipsychotic treatment. METHODS: Eleven medication-naive patients, diagnosed with acute paranoid psychosis with associated EEG abnormalities, were divided into two treatment groups: sole fluphenazine group, with flexible dosing of 5-10 mg/day (n=6), and carbamazepine group (n=5) with the addition of carbamazepine (600 mg/day) to fluphenazine treatment. Clinical Global Impression (CGI), Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Negative Symptoms (SANS), and EEG were assessed on the baseline and after 6 weeks of treatment. Paired and two-tailed t-tests were used for statistical significance. RESULTS: All the patients showed significant improvement of mental state after 6 weeks of treatment with no significant differences in CGI, BPRS, and total SANS scores in relation to the therapy with carbamazepine. Nevertheless, after 6 weeks of the treatment, EEG findings were significantly better in carbamazepine group, in relation to the findings from the onset of the treatment, as well as in comparison to sole fluphenazine group. CONCLUSION: Although carbamazepine stabilized abnormal brain electrical activities it seemed that the associated EEG abnormalities were not significant for acute psychosis observed. These preliminary results suggested that there was no convincing evidence that carbamazepine was efficient as the augmentation of antipsychotic treatment for patients with both acute paranoid psychosis and EEG abnormalities.     

Alcohol consumption, arterial blood pressure and general mortality rate--twenty-years follow-up study

BACKGROUND: Alcohol consumption has both adverse and beneficial effects on health and survival. The aim of this prospective study was to examine the association between alcohol consumption and arterial hypertension as well as general mortality rate. METHODS: The study included 286 participants, middle-aged men and women examined in 1974, and again in 1994 during twenty years of follow-up (mean age at the beginning of the study 43.61 +/- 7.09 years). Alcohol consumption was assessed by the specific questionnaire. Consumption levels were grouped into three categories: rare drinkers (consuming less than 6 drinks a week), moderate drinkers, who consume 1-2 alcohol drinks a day and heavy drinkers (consumers of 3 or more drinks a day). RESULTS: In both phases of the follow-up the lowest values of systolic and diastolic pressure were recorded in the group with moderate alcohol consumption, and the highest values in the group with excessive consumption. The observed differences were statistically significant. The general mortality rates were the highest among participants reporting excessive alcohol consumption (relative risk 3.2; 95% confidence interval 1.84-5.62), and among the abstainers (relative risk 1.8; 95% confidence interval 0.99-3.36), compared to the moderate consumption group. CONCLUSION: Analysis of the obtained results suggested the protective effect of moderate alcohol consumption on cardiovascular system.     

Soldier's social adaptation during the military service

Soldier's social adaptation includes his interpersonal relationships with his environment integration into the military community and the ability to fulfill his role in the military environment and to function adequately outside of it. The aim of this study was to establish the dynamics of soldier's social adaptation during the military service. The study involved soldiers of two platoons of the Armed Forces of Serbia and Montenegro, divided into three groups according to the period of the study: after the first month, after the basic training and at the end of the military service. The instruments applied for the study were sociodemografic questionnaire and Social Adaptation Self-evaluation Scale. Statistical analysis of the obtained data was done using Stident's t-test. The results of the study that soldier's contentment with his professional role and with the quality of his interpersonal relations was highest during the basic training, but the quality of leisure activities was lowest at the end of the military service.