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Manestar D, Malvic G, Velepic M, Vukelic J, Vrebac I, Tudor F, Vukelic I, Braut T. Perioperative substitution testosterone therapy in patients with advanced head and neck squamous cell carcinoma. Crit Rev Oncol Hematol 2023:104062. [PMID: 37385306 DOI: 10.1016/j.critrevonc.2023.104062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 06/04/2023] [Accepted: 06/25/2023] [Indexed: 07/01/2023] Open
Abstract
Testosterone replacement therapy is becoming more and more popular in men as "anti-aging medicine". Testosterone has beneficial effects on body mass and muscle gain, and much research has examined testosterone in palliative cancer therapy for oncology patients. In addition to direct effects on weight gain, testosterone improves mood and self-confidence, strength, libido, muscle mass, bone density, and cognitive functions and reduces the risk of cardiovascular disease. Lower testosterone levels are found in 65% of male patients with progressive tumors compared to only 6% of men in the general population. We hypothesize that perioperative substitution testosterone therapy (PSTT) together with a balanced diet, may be more effective than balanced diet alone in the overall treatment outcome of patients with head and neck squamous cell carcinomas. Therefore, PSTT in combination with a balanced diet should be considered as an additional tool for head and neck carcinoma treatment.
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Affiliation(s)
- Dubravko Manestar
- Clinic for Otorhinolaryngology and Head and Neck Surgery, Clinical Hospital Centre Rijeka, Kresimirova 42, Rijeka, Croatia; Faculty of Medicine, University of Rijeka, Brace Branchetta 20, Rijeka, Croatia
| | - Goran Malvic
- Clinic for Otorhinolaryngology and Head and Neck Surgery, Clinical Hospital Centre Rijeka, Kresimirova 42, Rijeka, Croatia; Faculty of Medicine, University of Rijeka, Brace Branchetta 20, Rijeka, Croatia
| | - Marko Velepic
- Clinic for Otorhinolaryngology and Head and Neck Surgery, Clinical Hospital Centre Rijeka, Kresimirova 42, Rijeka, Croatia; Faculty of Medicine, University of Rijeka, Brace Branchetta 20, Rijeka, Croatia
| | - Jelena Vukelic
- Faculty of Medicine, University of Rijeka, Brace Branchetta 20, Rijeka, Croatia; Department for Audiology and Speech Language Pathology, Clinical Hospital Centre Rijeka, Kresimirova 42, Rijeka, Croatia
| | - Ilinko Vrebac
- Clinic for Otorhinolaryngology and Head and Neck Surgery, Clinical Hospital Centre Rijeka, Kresimirova 42, Rijeka, Croatia; Faculty of Medicine, University of Rijeka, Brace Branchetta 20, Rijeka, Croatia.
| | - Filip Tudor
- Clinic for Otorhinolaryngology and Head and Neck Surgery, Clinical Hospital Centre Rijeka, Kresimirova 42, Rijeka, Croatia; Faculty of Medicine, University of Rijeka, Brace Branchetta 20, Rijeka, Croatia
| | - Ivan Vukelic
- Faculty of Medicine, University of Rijeka, Brace Branchetta 20, Rijeka, Croatia; Clinic for Urology, Clinical Hospital Centre Rijeka, Tome Strizica 3, Rijeka
| | - Tamara Braut
- Clinic for Otorhinolaryngology and Head and Neck Surgery, Clinical Hospital Centre Rijeka, Kresimirova 42, Rijeka, Croatia; Faculty of Medicine, University of Rijeka, Brace Branchetta 20, Rijeka, Croatia
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Velepič M, Manestar D, Perković I, Škalamera D, Braut T. Inhalation Aerosol Therapy in the Treatment of Chronic Rhinosinusitis: A Prospective Randomized Study. J Clin Pharmacol 2019; 59:1648-1655. [DOI: 10.1002/jcph.1471] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 05/31/2019] [Indexed: 01/16/2023]
Affiliation(s)
- Marko Velepič
- Clinic of Otorhinolaryngology Head and Neck SurgeryClinical Medical Centre, University of Rijeka Rijeka Croatia
| | | | - Ivona Perković
- Clinic of Otorhinolaryngology Head and Neck SurgeryClinical Medical Centre, University of Rijeka Rijeka Croatia
| | - Dunja Škalamera
- Clinic of Otorhinolaryngology Head and Neck SurgeryClinical Medical Centre, University of Rijeka Rijeka Croatia
| | - Tamara Braut
- Clinic of Otorhinolaryngology Head and Neck SurgeryClinical Medical Centre, University of Rijeka Rijeka Croatia
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Vučinić D, Zahirović D, Manestar D, Belac-Lovasić I, Braut T, Kovač L, Jonjić N, Zamolo G. Recurrent amelanotic melanoma of nasal cavity: Biological variability and unpredictable behavior of mucosal melanoma. A case report. Clin Pract 2019; 9:1157. [PMID: 31285816 PMCID: PMC6589532 DOI: 10.4081/cp.2019.1157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 05/27/2019] [Indexed: 11/23/2022] Open
Abstract
The aim of this report is to present a case of a patient with a recurrent nasal cavity amelanotic melanoma (AM), with emphasis on diagnosis and therapy options of this clinical entity. A 65-year-old female patient presented with pain in the right cheek region and nasal obstruction. In 2013, she was diagnosed with mucosal melanoma (MM) of the left nasal cavity. After endoscopic surgery and radiotherapy, the patient was followed by the oncology team. Five years after the initial diagnosis, rhinoscopy showed a tumorous formation in the right nasal cavity. The tumor mass was without black discoloration and was the same color as the surrounding nasal mucosa. Microscopic examination after biopsy of the tumor confirmed amelanotic MM. The patient underwent an additional endoscopic surgery. A complete standard diagnostic workup for MM found metastases in head and neck lymph nodes, on both sides. MMs of head and neck are uncommon malignancies. Unique biology of MM cells causes a high rate of recurrences. This report presents an example of recurrent AM of the nasal cavity, in treatment with checkpoint inhibitor (pembrolizumab), which could provide a good therapy option for patients with MM.
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Affiliation(s)
| | - Dag Zahirović
- Department of Radiotherapy and Oncology, Clinical Hospital Centre Rijeka
| | - Dubravko Manestar
- Faculty of Medicine, University of Rijeka.,Clinic of Otorhinolaryngology, Head and Neck Surgery, Clinical Hospital Centre Rijeka
| | - Ingrid Belac-Lovasić
- Faculty of Medicine, University of Rijeka.,Department of Radiotherapy and Oncology, Clinical Hospital Centre Rijeka
| | - Tamara Braut
- Faculty of Medicine, University of Rijeka.,Clinic of Otorhinolaryngology, Head and Neck Surgery, Clinical Hospital Centre Rijeka
| | - Leo Kovač
- Department of Pathology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Nives Jonjić
- Department of Pathology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Gordana Zamolo
- Department of Pathology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
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Affiliation(s)
- Dubravko Manestar
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Rijeka, Rijeka, Croatia
| | - Sven Maričić
- Faculty of Engineering, University of Rijeka, Rijeka, Croatia
| | - Dean Komljenović
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Rijeka, Rijeka, Croatia
| | - Damir Miletić
- Department of Radiology, University Hospital Rijeka, Rijeka, Croatia
| | | | - Emanuel Borović
- Department of Anesthesiology and Intensive Care Unit, University Hospital Rijeka, Rijeka, Croatia
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Velepic MM, Manestar D, Starcević R, Velepic BC, Velepic SZ, Linsak Z. Full thickness cartilage palisade tympanoplasty with malleus interposition: a study of the long term results. Coll Antropol 2014; 38:283-287. [PMID: 24851631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The aim of this retrospective study is to review long term results of full-thickness cartilage palisade tympanoplasty (FTCPT) with malleus head interposition performed on 51 patients (56 ears); 36 women and 15 men (7-73 years, 44 years average). The pathology of ears which encourages this technique of tympanoplasty is presented. On average 12 years after surgery we have elaborated anatomic and functional results. Anatomic results were categorized based on empiric evaluation of the new tympanic membrane status: 40 (71%) tympanic membranes without anatomic irregularities, 14 (25%) with irregularities and 2 (4%) with secondary perforation. Functional results (tonal audiogram) are based on pure tone average air-bone gap (PTA-ABG) at 4 frequencies. Main functional results of 51 ears (51 audiograms performed): pre- and post-operative average PTA-ABGs were 27.07 +/- 9.98 and 10.77 +/- 7.85 dB (t = 10.36; p < 0.001). In the group of ears with a tympanic membrane with no anatomic irregularities, pre- and post-operative average PTA-ABGs were 27.30 +/- 10.56 and 10.82 +/- 8.33 dB (t = 8.09; p < 0.001). In the group of ears with cartilage resorption, pre- and post-operative PTA-ABGs were 24.92 +/- 8.19 and 9.33 +/- 6.58 dB (t = 6.21; p < 0.001). The differences between the two groups are irrelevant. Postoperative PTA-ABG values of ears after first surgery (N = 34) and revision surgery (N = 17) was significantly different (8.75 +/- 5.75 and 15.16 +/- 9.62 dB) (t = 2.60; p = 0.016). In spite of the thickness of the new tympanal membrane, FTCPT is a successful technique for solving advanced ear pathology.
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Manestar D, Tićac R, Manestar K, Linsak Z, Corak D, Kavanagh MM, Prgomet D, Starcević R. Postlaryngectomy olfactory rehabilitation and swimming. Coll Antropol 2013; 37:1147-1152. [PMID: 24611327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The aim of the study was to determine the influence of swimming on postlaryngectomy olfactory rehabilitation. This prospective open interventional trial at a tertiary academic hospital included 100 laryngectomised patients; 17 were swimmers and 83 were nonswimmers. Participants practiced the polite yawning technique (PYT) for postlaryngectomy olfactory rehabilitation. Rhinomanometry was used to measure air quantity in the right and left nostrils, respectively; to test sense of smell, we applied the smell diskettes olfaction test (SDOT). Swimmers used swimming aids and swam only in a pool accompanied by another person trained in the rescue and resuscitation of a laryngectomee. Measures were made at three time points. Following PYT initiation, the number of accurately guessed odours was higher among swimmers (SDOT1 = 5.29, SDOT2 = 6.40, SDOT3 = 6.76) than nonswimmers (SDOT1 = 3.73, SDOT2 = 5.48, SDOT3 = 5.60) as were airflows through the left (swimmers: FL1 = 40.82, FL2 = 137.71, FL3 = 172.80; nonswimmers: FL1 = 13.05, FL2 = 104.63, FL3 = 113.00) and right nostrils (swimmers: FR1 = 46.82, FR2 = 115.41, FR3 = 145.40; nonswimmers: FR1 = 13.70, FR2 = 92.77, FR3 = 106.43). The number of odours identified by laryngectomised patients increased with the volume of nasal airflow, but this number and the efficiency of olfactory rehabilitation were higher in swimmers compared to nonswimmers. Swimming with a swimming aid improved the quality of life after surgery and may facilitate resocialisation of laryngectomised patients.
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Affiliation(s)
- Dubravko Manestar
- University of Rijeka, University Hospital Rijeka, Clinic of Otorhinolaryngology, Head and Neck Surgery, Rijeka, Croatia.
| | - Robert Tićac
- University of Rijeka, University Hospital Rijeka, Clinic of Otorhinolaryngology, Head and Neck Surgery, Rijeka, Croatia
| | - Koraljka Manestar
- University of Rijeka, University Hospital Rijeka, Pediatric Clinic, Rijeka, Croatia
| | - Zeljko Linsak
- Teaching Institute of Public Health, Rijeka, Croatia
| | - Davor Corak
- Teaching Institute of Public Health, Rijeka, Croatia
| | - Marcel Marjanović Kavanagh
- University of Zagreb, University Hospital Zagreb, Clinic of Otorhinolaryngology, Head and Neck Surgery, Zagreb, Croatia
| | - Drago Prgomet
- University of Zagreb, University Hospital Zagreb, Clinic of Otorhinolaryngology, Head and Neck Surgery, Zagreb, Croatia
| | - Radan Starcević
- University of Rijeka, University Hospital Rijeka, Clinic of Otorhinolaryngology, Head and Neck Surgery, Rijeka, Croatia
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Linsak Z, Linsak DT, Glad M, Cenov A, Coklo M, Coklo M, Manestar D, Mićović V. Ecotoxicological characterization of marine sediment in Kostrena coastal area. Coll Antropol 2012; 36:1401-1405. [PMID: 23390841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Samples of marine sediment were taken on 4 selected sites close to the shipyard industry in Kostrena coastal area. Concentration of polycyclic aromatic hydrocarbons (PAHs), polychlorinated biphenyls (PCBs) and heavy metals (Cu, Pb, Zn, Hg, Fe) were analyzed from chemical-analytical and toxicological aspect. For toxicity detection, the bacterial bioluminescence test (Vibrio fisheri) was used. Concentration of total PAHs varied in the range from 697 to 7807 microg/kg dry weight in marine sediments. The concentration of PCBs in sediment was 1.1 mg/kg dry weight. The highest concentrations of heavy metals were found at the station within the shipyard. PAH toxicity was not correlated with the toxic potential of sediments. The obtained results indicate a high degree of environmental risk, especially at stations within the shipyard, with the 54% possibility of toxic effects. Chemical determination of the concentration of conventional pollutants is not sufficient for assessing the quality of the marine environment and it is necessary to use other approaches in order to evaluate the biological impact.
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Affiliation(s)
- Zeljko Linsak
- Teaching Institute of Public Health of Primorsko-Goranska County, Rijeka, Croatia.
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Braut T, Kujundzić M, Vukelić J, Manestar D, Krstulja M, Starcević R, Grahovac B. Gene amplification of epidermal growth factor receptor in atypical glottic hyperplasia. Coll Antropol 2012; 36 Suppl 2:87-91. [PMID: 23397762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The study searched for epidermal growth factor receptor (EGFR) gene amplification in hyperplastic glottis lesions. After classical pathohistological findings of hematoxylin-eosin (HE) slides and quantitative immunohistochemical (IHC) analysis, fluorescent in situ hybridization (FISH) was used on tissue microarrays of laryngeal hyperplastic tissue ranging from normal mucosa to abnormal and atypical hyperplastic lesions. FISH analysis of two atypical hyperplastic lesions discovered the amplification of EGFR gene while it was not found in simple and abnormal hyperplastic lesions. The results may indicate that EGFR gene amplifications could possibly correlate with the histopathologic picture. Tissue samples burdened with specific oncogen signatures like EGFR gene amplification could be detected in precancerous lesion. This might improve follow-up and treatment protocols of glottic lesions which are an everyday problem for ENT practitioners. Further research is mandatory to confirm our findings.
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Affiliation(s)
- Tamara Braut
- University of Rijeka, Rijeka University Hospital Center, Clinic of Otorhinolaryngology, Head and Neck Surgery, Rijeka, Croatia
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Malvić G, Manestar D, Krstulja M, Corak D, Candrlić B, Kujundzić M, Velepic M, Starcević R. Juvenile angiofibroma of the maxillary sinus. Coll Antropol 2012; 36 Suppl 2:197-199. [PMID: 23397786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Juvenile angiofibromas are benign fibro-vascular tumours of the nasopharynx that develop in prepubertal and adolescent males. Typical symptoms are longstanding unilateral nasal obstruction occasionally followed by epistaxes and frequent severe intraoperative haemorrhage of the discovered mass. We report the case of a 14-year-old boy histologically diagnosed with a juvenile angiofibroma in spite of the atypical localisation of the polyploid mass of the left maxillary sinus.
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Affiliation(s)
- Goran Malvić
- University of Rijeka, Rijeka University Hospital Center, Clinic of Otorhinolaryngology, Head and Neck Surgery, Rijeka, Croatia.
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Manestar D, Braut T, Kujundžić M, Malvić G, Velepič M, Donadić Manestar I, Matanić Lender D, Starčević R. The effects of disclosure of sequential rhinomanometry scores on post-septoplasty subjective scores of nasal obstruction: a randomised controlled trial. Clin Otolaryngol 2012; 37:176-80. [PMID: 22564336 DOI: 10.1111/j.1749-4486.2012.02490.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We sought to evaluate the effects of awareness of rhinomanometric results on subjective sensation of nasal breathing in patients after septoplasty. DESIGN Prospective randomised study. SETTING Clinical Hospital Rijeka. PARTICIPANTS A study of 60 patients (45 M, 15 F) who underwent septoplasty was performed at the ENT Clinic, Clinical Hospital Rijeka. The patients were randomised into two groups; group A was shown their rhinomanometry scores at 3 months postoperatively, while group B remained unaware of their rhinomanometry results. MAIN OUTCOME MEASURE The assumption is that in the same settings patients aware of their rhinomanometric results have better performances of their Nasal Obstruction Symptom Evaluation (NOSE) scale and thereby a better quality of life (QOL) after septoplasty. RESULTS The differences in rhinomanometric results and NOSE scale prior and after septoplasty were statistically significant (P < 0.001), all patients achieving better results after the operation. There was no statistically significant difference in resistance (F = 0.004; P = 0.948) and improvement of rhinomanometry results in postoperative measurements (F = 0.110; P = 0.896) between groups A and B. The symptoms measured by the NOSE scale were the same in both groups preoperatively and 1 month after septoplasty (F = 2.906; P = 0.094). Three months postoperatively in group A, the NOSE scale score was lower (M = 11.67; sd = 12.34) than in group B (M = 27.50; sd = 18.04). CONCLUSIONS The results suggest that disclosing information to patients about their post-septoplasty rhinomanometry results may improve subjective nasal breathing, and thus improve their QOL.
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Affiliation(s)
- D Manestar
- Clinic of Otorhinolaryngology, Head and Neck Surgery Clinic of Ophthalmology Clinic of Pulmology, University Hospital Rijeka, Rijeka, Croatia
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Manestar D. Response to Dr Joseph. Clin Otolaryngol 2012. [DOI: 10.1111/coa.12012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kujundzić M, Braut T, Manestar D, Cattunar A, Malvić G, Vukelić J, Puselja Z, Linsak DT. Water related otitis externa. Coll Antropol 2012; 36:893-897. [PMID: 23213950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Water influences skin inflammation of the external auditory canal. The common term for this illness is "swimmer's ear". Contributory factors are length of exposure to water, type of water and water pollution. The aim of the study was to compare risks for contracting the disease between patients with different exposure to swimming pool water. A retrospective case-control analysis of patients at the ENT-clinic was performed. Swimmers and water polo players swam in a swimming pool chlorinated by an automatic swimming pool cleaning system. Water sport players had a higher risk for ear skin inflammation than football players. Senior football players compared with players younger than 13 were not at increased risk. Swimmers and water polo players older than 13 were at higher risk. Swimmers were at higher risk than football players as well as water polo players. There was no difference for the risk of otitis externa between swimmers and water polo players. Swimmers and water polo players compared with other patients of the ENT-clinic were at higher risk than football players. Frequent and longer exposure to water has been proved to increase the risk of external auditory canal inflammation.
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Affiliation(s)
- Milodar Kujundzić
- University of Rijeka, Rijeka University Hospital Center, Clinic of Otorhinolaryngology, Head and Neck Surgery, Rijeka, Croatia
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Manestar D, Tićac R, Maričić S, Malvić G, Čorak D, Marjanović Kavanagh M, Prgomet D, Starčević R. Amount of airflow required for olfactory perception in laryngectomees: a prospective interventional study. Clin Otolaryngol 2012; 37:28-34. [PMID: 22257443 DOI: 10.1111/j.1749-4486.2012.02442.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine minimum airflow rate required for olfactory stimulation in successfully rehabilitated laryngectomised patients after learning the polite yawning technique (PYT) and to confirm the hypothesis that sense of smell is rehabilitated once the nasal airflow is re-established. DESIGN Prospective open interventional trial. SETTING Tertiary academic hospital. PARTICIPANTS The study population comprised 100 laryngectomised patients. The control group consisted of 100 non-laryngectomised patients of similar age and sex. Rhinomanometry was used to measure air flow in the right and left nostrils, respectively, while the Smell Diskettes Olfaction test (SDOT) was used to test each individual's sense of smell. MAIN OUTCOME MEASURES The primary endpoint was increasing the airflow, while the secondary endpoint was improvement in the Smell Diskettes Olfaction test score after learning the polite yawning technique. RESULTS The difference in the Smell Diskettes Olfaction test results before and after introducing the polite yawning technique was statistically significant (F = 53.077; P < 0.001). The number of accurately identified odours increased with each measurement. There was a significant difference among rhinomanometric measurements of airflow through the right (F = 65.002; P < 0.001) and left nostrils (F = 75.465; P < 0.001). Nasal airflow improved with each measurement. The minimum airflow required for olfactory stimulation in successfully rehabilitated patients was approximately 60 cm(3) /s. The control group had considerably better airflow in both nostrils than the laryngectomised group. The difference between the total number of rehabilitated (normosmic) patients (48%) in the laringectomised group and normosmic participants (56%) in the control group (z = 1.132; P = 0.129) was not statistically significant. CONCLUSION The number of odours identified by laryngectomised patients increased with the volume of nasal airflow. The number of patients with rehabilitated olfactory function approximated the percentage of normosmic individuals in the non-laryngectomised population. These findings confirm the hypothesis that sense of smell is rehabilitated once the nasal airflow is re-established.
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Affiliation(s)
- D Manestar
- Clinic of Otorhinolaryngology, Head and Neck Surgery, University Hospital Rijeka, Rijeka, Croatia.
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Velepic M, Manestar D, Ahel VV, Linsak Z, Malvić G. Mucormycosis of the nasal ala in a leukemic (M7 AML) child. Is surgery of the nasal defect indicated? Coll Antropol 2012; 36:535-537. [PMID: 22856241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Anterior tamponade with Surgicel (oxidized cellulose) was performed on a 5-year-old girl with megakaryoblastic leukemia (M7 AML) and epistaxis. Several days later necrosis of the nasal ala occurred. Debridement was performed and mucormycosis caused by Rhizopus was found in the material. Having cured mucormycosis, a defect of the complete nasal ala remained. The question of a surgical resolution of the disfiguring nasal defect arises.
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Affiliation(s)
- Marko Velepic
- University of Rijeka, Rijeka University Hospital Center, Clinic of Otorhinolaryngology, Head and Neck Surgery, Rijeka, Croatia
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Manestar D, Tićac R, Starcević R, Sepić T, Malvić G, Marijić B, Bonifacić D. Voice rehabilitation of Broca's aphasia following total laryngectomy. Coll Antropol 2012; 36:313-315. [PMID: 22816238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Total laryngectomy, as a consequence of carcinoma of the larynx, results in loss of speech function. Cerebrovascular stroke is the leading cause of reduced speech production ability, and thereby communication difficulties. The case is presented of a 60-year-old male patient who suffered stroke five years after a total laryngectomy. Speech rehabilitation was hampered due to the depressive state of the patient. Although contraindicated, the secondary voice prosthesis was implanted. Only at that moment the patient showed willingness and motivation for speech rehabilitation. The aim of this presentation is to demonstrate that not all neurological disorders are contraindicated for implantation of voice prostheses.
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Affiliation(s)
- Dubravko Manestar
- University of Rijeka, Rijeka University Hospital Center, Clinic of Otorhinolaryngology, Head and Neck Surgery, Rijeka, Croatia.
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Manestar D, Ticac R, Velepic M, Braut T, Manestar-Donadic I, Manestar K, Malvic G, Starcevic R. The significance of rhinomanometry in evaluation of postlaryngectomy olfactory rehabilitation by polite yawning technique. Rhinology 2011; 49:238-42. [PMID: 21743884 DOI: 10.4193/rhino10.109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To corroborate the result of postlaryngectomy olfactory rehabilitation evaluating the efficacy of the Polite Yawning Technique (PYT) with rhinomanometry and odours with the Smell diskettes Olfaction test (SDOT). MATERIALS AND METHODS Thirty-two laryngectomised patients were subjected to olfactory rehabilitation consisting of 15-minute training and independent exercising for two weeks. The sense of smell and nasal airflow in laryngectomised patients were examined before and after implementation of PYT. RESULTS The differences in SDOT results prior to and after introduction of PYT were statistically significant, most patients achieving better results after rehabilitation. A significant positive correlation was obtained in results of SDOT and rhinomanometry prior to and after introduction of PYT. The results of measurements after rehabilitation showed that 75% of patients had improved nasal breathing, 78% of patients had a better sense of smell and 40% of patients became normosmic. CONCLUSIONS PYT has proved to be an effective method in olfaction rehabilitation following total laryngectomy. Using rhinomanometry, evaluation of the rehabilitation success is substantiated while the technique is simplified.
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Affiliation(s)
- D Manestar
- Department of Otorhinolaryngology, Head and Neck Surgery, Clinical Hospital Centre Rijeka, Rijeka, Croatia.
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Manestar D, Ticac R, Velepic M, Braut T, Manestar-Donadic I, Manestar K, Malvic G, Starcevic R. The significance of rhinomanometry in evaluation of postlaryngectomy olfactory rehabilitation by polite yawning technique. Rhinology 2011. [DOI: 10.4193/rhin10.109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Velepic M, Starcevic R, Bonifacic M, Ticac R, Kujundzic M, Udovic DS, Manestar D, Malvic G, Zubovic S, Velepic M. The clinical status of the eardrum: an inclusion criterion for the treatment of chronic secretory otitis media in children. Int J Pediatr Otorhinolaryngol 2011; 75:686-90. [PMID: 21397957 DOI: 10.1016/j.ijporl.2011.02.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 02/13/2011] [Accepted: 02/15/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate if the clinical status of the eardrum could be an inclusion criterion for the therapy of chronic secretory otitis media (CSOM). To compare the results of treating CSOM by adenoidectomy and by adenoidectomy in combination with tympanostomy tubes in two groups of patients chosen according to that criterion. METHODS 161 ears in 87 children were treated for CSOM. An otomicroscopic examination showed there were no pathological changes on the tympanic membrane (signs of adhesive process, malleus rotation, and dangerous attic retractions). The patients were randomly divided into two groups: the first group of 59 ears was treated by myringotomy and tympanostomy tubes and adenoidectomy, while the other group of 102 ears was treated only by adenoidectomy. At least 6 months after the treatment, otomicroscopy and audiological assessments were performed in order to show the resolution of the middle ear effusion (MEE), audiological results and incidence of clinical sequelae of the eardrum. RESULTS The resolution of MEE by adenoidectomy alone was not significantly different from the results of treatment by adenoidectomy and tympanostomy tubes (z=1.565; p=0.0587). There were no differences in pure tone audiometry between the two methods of treatment. Only at the frequency of 2000 Hz (t=2.173; p=0.031) in treatment with adenoidectomy and tympanostomy tubes the values of air-bone gap (ABG) were lower. Sequelae: scars of the eardrum (chi-square=28.107; ss=1; p<0.001) and attic retractions (chi-square=4.592; ss=1; p=0.032) were more often in treatment with tubes. The incidence of clinical sequelae on the eardrum after treatment by tubes was commented on. CONCLUSION A criterion that could influence the approach to the therapy of CSOM in children.
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Affiliation(s)
- Marko Velepic
- Clinic of Otorhinolaryngology Head and Neck Surgery, Clinical Medical Center University of Rijeka, Croatia
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Rosso M, Marjanović K, Males J, Sepić T, Segec I, Rosso M, Manestar D. Bilateral laryngoceles in association with squamos cell carcinoma: a case report and literature review. Coll Antropol 2010; 34:727-730. [PMID: 20698163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Coexistence of laryngoceles and laryngeal carcinoma is still being debated, and there are several suggested theories about the pathophysiological relationship between these two entities. We present the case of a 66-year-old male patient with bilateral laryngomucoceles and laryngeal squamos cell carcinoma. A systematic hystological examination of whole organ sections showed that the submucosal spreading of cancer around the saccular necks on both sides caused stenosis which probably created a one-way valve mechanism allowing air to enter the saccule but not to exit. Progression of the tumor completely obstructed the laryngeal opening, leading to glandular secretion stagnation and formation of laryngomucoceles.
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Affiliation(s)
- Marinela Rosso
- Department of Otorhinolaryngology and Head and Neck Surgery, Osijek University Hospital Center, Osijek, Croatia.
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Braut T, Krstulja M, Kujundzić M, Manestar D, Hadzisejdić I, Jonjić N, Grahovac B, Manestar D. Epidermal growth factor receptor protein expression and gene amplification in normal, hyperplastic, and cancerous glottic tissue: immunohistochemical and fluorescent in situ hybridization study on tissue microarrays. Croat Med J 2009; 50:370-9. [PMID: 19673037 DOI: 10.3325/cmj.2009.50.370] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM To evaluate the importance of epidermal growth factor receptor (EGFR) protein overexpression and gene amplification in carcinogenesis of glottic cancer. METHOD In order to evaluate EGFR expression at protein and gene level, immunohistochemical (IHC) analysis and fluorescent in situ hybridization (FISH) were performed on tissue microarrays of laryngeal tissue (145 samples) -- 38 samples of normal mucosa, 46 samples of hyperplastic lesions, and 61 samples of cancerous lesions. RESULTS Membranous (mEGFR) and cytoplasmic (cEGFR) EGFR expression was significantly different between the analyzed groups. The differences were most striking in the suprabasal-transforming zone. IHC evaluation showed that high and low mEGFR staining contributed to the differentiation of dysplastic lesions, simple hyperplasia, and cancerous tissue, as well as between different degrees of atypia in hyperplastic lesions (P<0.050). EGFR gene amplification was not found in simple and abnormal hyperplastic lesions, but it was confirmed in 2/21 atypical hyperplasias, indicating that gene amplification can facilitate identification of malignant potential in hyperplastic lesions. In cancerous tissue, EGFR gene amplification was found in 8/50 samples. EGFR gene amplification was found in preinvasive cancer in one patient. In invasive carcinomas, gene amplification was not associated with stage or grade. Carcinomas with gene amplification showed significantly higher cEGFR expression (basal layer P=0.003; suprabasal layer P=0.002). CONCLUSIONS This study confirmed an increase in EGFR protein expression and gene amplification with the increase in biological aggressiveness of glottic lesions. A correlation between EGFR gene amplification and protein expression was established. Gene amplification proved to be an early event in glottic carcinogenesis, indicating its importance for glottic cancer prevention, early detection, and protocol selection.
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Affiliation(s)
- Tamara Braut
- Department of Otorhinolaryngology, Head and Neck Surgery, Clinical Hospital Center Rijeka, Kresimirova 42, 51000, Rijeka, Croatia
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Abstract
OBJECTIVE To compare sequelae of chronic tubotympanal disorders in children with and without gastroesophageal reflux (GER). MATERIAL AND METHODS In 32 patients with chronic tubotympanal disorders GER was studied by means of 24-h continuous esophageal pH monitoring. After a period of 2-6 years (mean 4 years) sequelae of the tubotympanal disorders were examined, together with the clinical status of the ears and hearing status. The criteria for classification into mild, moderate and severe sequelae were based on the clinical status of the ear. Hearing was determined using tonal audiograms. Conductive hearing loss was classified as either slight (< or = 35 dB hearing loss in speech frequencies) or severe (>35 dB hearing loss in speech frequencies). RESULTS In the group of 16 patients (mean age 6.1 years) with GER, sequelae were observed in 29 ears (mild, n=11; moderate, n=5; severe, n=13). Hearing impairment was determined in 20 ears (mild, n=8; severe, n=12). In the group of 16 patients (mean age 7.1 years) without GER, sequelae were observed in 17 ears (mild, n=11; moderate, n=1; severe, n=5). Hearing impairment was determined in 10 ears (mild, n=6; severe, n=4). CONCLUSION The total number of ears with sequelae and the total number of ears with conductive hearing impairment were significantly higher in patients with GER.
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Affiliation(s)
- Marko M Velepic
- Otorhinolaryngology, Rijeka University Medical School, Rijeka, Croatia.
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Skarpa I, Rubesa G, Moro L, Manestar D, Petrovecki M, Rukavina D. Changes of cytolytic cells and perforin expression in patients with posttraumatic stress disorder. Croat Med J 2001; 42:551-5. [PMID: 11596172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
AIM To define phenotypic characteristics of cytotoxic T lymphocytes (CTL) and natural killer cells (NK) in peripheral blood, frequency of somatic symptoms, and level of anxiety and depression in 25 patients clinically diagnosed with chronic post-traumatic stress disorder (PTSD). METHODS Patients were divided into two sub-groups according to the stressor: 18 PTSD patients with the battlefield experience and 7 PTSD patients with battlefield experience who were tortured as the prisoners of war (POW) in Bosnian-Serbian camps. The control group consisted of 15 healthy volunteers matched to the patients by sex and age. We tested all patients using Becks depression inventory, Spielberger anxiety test, and somatic disturbance list, and analyzed their peripheral blood lymphocytes using flow cytometry with the double fluorescence staining of cell surface antigens (CD3, CD4, CD8, CD16, and CD56) and intracellular cytolytic molecule perforin (P), a mediator of cytolytic action at the molecular level. RESULTS All PTSD patients showed a significant level of anxiety, depression, and numerous somatic symptoms. The only significant difference between PTSD patients with and without POW experience was in the anxiety level (median, 71; range 61-79; vs median, 65; range, 49-77). PTSD patients with POW experience had significantly higher levels of CD16+ cells (median, 37%; range, 16-55%) than those without it (median, 12%; range, 5-37%). Double labeling for intracellular P antigen and cell surface antigens showed the highest levels of CD16+P+ (median, 33%; range, 15-40%; vs median, 10%; range, 3-29%) and CD56+P+ (median, 21%; range, 11-40%; vs median 8%; range, 1-30%) cells in PTSD-POW patients. CONCLUSION Chronic PTSD patients who survived concentration camps show the most numerous alterations in PBL phenotype, the highest number of perforin-containing cells, and a significantly higher level of anxiety.
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Affiliation(s)
- I Skarpa
- Department of Psychiatry, Rijeka University School of Medicine, B. Branchetta 20, 51000 Rijeka, Croatia
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Abstract
OBJECTIVE To determine whether a patient with a serious defect of the tympanic membrane (TM) will be able to dive after surgery. PATIENTS AND METHODS The authors describe three patients who were divers with serious defects of the TM (more than 75% of TM). In all three cases, cartilage palisade tympanoplasty was used to reconstruct the TM. RESULTS Six months after surgery, the patients passed clinical examinations, audiograms (hearing restored to normal), tympanometry (increased stiffness of the TM), and pressure tolerance tests in hyperbaric chamber (30-m immersion was simulated for 4 minutes), and they began to dive again. Approximately 2 years after the surgery, all three patients are able to dive without any difficulties. CONCLUSION The authors conclude that patients can dive after cartilage palisade tympanoplasty.
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Affiliation(s)
- M Velepic
- Clinic of Otorhinolaryngology, Rijeka University Medical School, Rijeka, Croatia
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Lajtman Z, Manestar D, Borcić V, Znaor T. Recruitment in the diagnosis of small PCA tumors. Acta Med Croatica 2001; 54:85-9. [PMID: 11028113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Acoustic brainstem response (ABR) waveforms were preoperatively analyzed in 86 cases of pontocerebellar angle (PCA) tumors. Absolute (APL) and interpeak latencies (IPL) ipsilateral to the tumor and interaural absolute latency differences of wave V (IAAPLD V) were normal in two patients with small intracanalicular tumors. However, results of latency-intensity studies were abnormal. So, if PCA tumor is suspected, and standard ABRs are normal by usual criteria, the latency-intensity functions should be examined before the test result is reported as negative for an acoustic nerve tumor.
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Affiliation(s)
- Z Lajtman
- Department of Otorhinolaryngology, Merkur University Hospital, Zagreb, Croatia
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Abstract
This retrospective study analyses the outcome of treatment of 61 patients with advanced carcinoma of the pyriform fossa. Thirty-two patients (group 1) underwent surgery and postoperative radiotherapy and 29 patients (group 2) had induction chemotherapy followed by radiotherapy. The local recurrence-free survival at 5 years from the completion of therapy for group 1 was 54%, compared to 61% for group 2. The 5-year neck recurrence-free survival for groups 1 and 2 were 54% and 59%, respectively. The 5-year overall survival rates for groups 1 and 2 were 19% and 14%, respectively. Non-surgical therapy for advanced stage pyriform fossa cancer provides survival comparable with that achieved with the standard approach of surgery and postoperative radiotherapy. We advocate radical irradiation as the method of choice because it provides nodal coverage to the bilateral jugular chains and retropharyngeal nodes, all known to be at risk for metastases, and is associated with lower morbidity compared to surgery. But, however, despite the therapy, the outcome is poor.
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Affiliation(s)
- Z Lajtman
- Department of Otorhinolaryngology, Clinical Hospital Merkur, Zagreb, Croatia
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Abstract
We report a case of lethal midline granuloma in a 34-year-old male patient. The patient was referred to our hospital because of long-lasting hoarseness. He was treated for granuloma laryngis. After two years nasal obstruction developed followed by ulceration of the hard palate and destruction of part of the nose and the upper lip. A biopsy demonstrated polymorphic infiltrate consisting of small lymphocytes, plasma cells, macrophages, atypical lymphoid cells and eosinophils. Radiotherapy was very effective and led to long-term remission. The different etiological aspects of this syndrome are discussed.
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Affiliation(s)
- G Zamolo
- Department of Pathology, Medical School, Rijeka, Croatia
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Manestar D, Braut T, Velepic M. Topical ciprofloxacin in long-lasting otorrhea. Arch Otolaryngol Head Neck Surg 1999; 125:236. [PMID: 10037296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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Rukavina D, Laskarin G, Rubesa G, Strbo N, Bedenicki I, Manestar D, Glavas M, Christmas SE, Podack ER. Age-related decline of perforin expression in human cytotoxic T lymphocytes and natural killer cells. Blood 1998; 92:2410-20. [PMID: 9746781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
In this study a flow cytometric technique for detecting cytoplasmic perforin (P) has been used to quantify age-related changes in perforin expression in human peripheral blood lymphocytes (PBL). Proportions of P+ lymphocytes increased after birth, but declined rapidly after the age of 70 years. This was true for both T cells and CD16(+) and CD56(+) natural killer (NK) cells. Children showed in addition to high levels of perforin positive CD8(+) cells a much higher proportion of CD4(+)P+ cells than the other age groups. In elderly individuals there was also a highly significant reduction in mean levels of perforin per cell as compared with all other groups (P < .05 to .001). Adult women had consistently higher mean levels of perforin per cell than adult men for all P+ cell phenotypes. Functional tests clearly showed the deficiency in early spontaneous cytotoxic potential of PBL from elderly persons due to relative P deficiency, which can be corrected by stimulation of cytolytic cells with target cells and interleukin-2 (IL-2). The deficiency in cytolytic activity on the contact with target cells may have implications for antiviral and antitumor immunity in elderly persons.
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Affiliation(s)
- D Rukavina
- Department of Physiology and Immunology, Medical Faculty, University of Rijeka, Rijeka, Croatia.
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Manestar D, Sustar N, Rubinić M, Maljevac B. [Use of planigraphy and endoscopy in the diagnosis of rhinoliths]. Lijec Vjesn 1985; 107:444-6. [PMID: 4068892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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