Browsing by Author "Jesic, S. (6603837859)"

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Corticosteroid hormones administered into the organism for therapeutic purposes have a certain effect on different organs and systems, especially on the endocrine system. It was interesting to find out the effect of corticosteroid therapy of different duration on the sympathetic adrenal system i.e. on urinary elimination of norepinephrine. The examination concerned 28 patients with systemic diseases and 8 healthy individuals who never were given corticosteroids. The patients were divided into 3 groups: 1). group on a short therapy; 2). group on a long therapy and 3). group on a prolonged therapy. The amount of norepinephrine in urine was determined by spectrophotofluorometric method. A multiphasic urinary elimination of norepinephrine was registered. After a short therapy corticosteroids provoked a decreased norepinephrine elimination i.e. a decreased activity of the sympathetic nervous system. After a several-month-therapy the elimination of norepinephrine returned to normal. However, after a prolonged corticosteroid therapy a definite decrease of sympathetic activity was observed. The result showed a positive correlation between norepinephrine excretion and administered dose of Pronison. The greatest fall of sympathetic activity was observed during small, suppressive doses of Pronison (5 mg daily). A prolonged administration of 80 mg doses increased urinary elimination of norepinephrine. This is possibly due to a central stimulating activity of corticosteroids on the sympathicus. It is concluded that a prolonged corticosteroid therapy provoked a fluctuation of sympathetic activity. Therefore the therapy should be intermittent. It is known that a prolonged corticosteroid treatment, especially a synthetic corticosteroid therapy, can provoke hypertension which is the consequence not only of water and salt retention, but also of increased sympathetic activity.

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Objective: To evaluate the efficacy of bilateral selective neck dissection of levels II–IV in elective and therapeutic management of the neck as a part of primary surgical treatment of patients with supraglottic laryngeal cancer and clinically negative cervical findings (N0). Design: Institutional, observational, case–control study with historic control of patients who underwent primary supraglottic tumour surgery, and a prospective cohort of patient, who underwent, besides the operation of primary tumour, bilateral selective neck dissection (level II–IV). Setting: University, tertiary level hospital, national referral centre. Participants: The study included 193 patients with supraglottic cancer and without palpable or ultrasound positive cervical findings who were surgically treated from 1988 to 2005. Besides the operation of primary tumour, all patients in the study group underwent bilateral selective neck dissection (level II–IV). Patients in the control group (N = 51) underwent primary tumour operation only and were followed up regularly. In cases with postoperative regional recurrences, the radical neck dissection was performed. All patients with histopathological confirmation of occult metastases were administered radiotherapy treatment (60 Gy) in the postoperative period. Main outcome measures: Five-year overall survival rate. Results: Occult cervical metastases were found in 18% of patients. They were present in level II in 77.5%, in level III in 20% of cases and in one patient in level IV (2.5%); the extracapsular spread was observed in 20% of cases. Postoperative regional metastases were found in 4.15% of cases in the study group, and in 11.8% in the control group, which proved to be significantly higher. The five-year overall survival rate showed no significant difference between the study group and the control group. Conclusion: The incidence of postoperative regional recurrences could be reduced by performing bilateral selective neck dissection simultaneously with primary tumour operation, but with no influence on the survival rate. © 2015 John Wiley & Sons Ltd

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