Abstract Background Pseudomyxoma peritonei (PMP) is a rare peritoneal malignancy most commonly originating from appendiceal mucinous neoplasms. Cytoreductive surgery (CRS) combined with has become the standard treatment for selected patients; however, evidence is largely based on retrospective single-centre series. We report the 15-year experience of the Slovenian National Referral Centre and evaluate long-term survival and prognostic factors following CRS and hyperthermic intraperitoneal chemotherapy (HIPEC). Patients and methods This retrospective study included all consecutive patients who underwent CRS and HIPEC for PMP between 2009 and 2024. Clinical, pathological, operative and follow-up data were prospectively collected and retrospectively analysed. Overall survival (OS) was the primary endpoint, while disease-free survival (DFS), postoperative morbidity and prognostic factors were secondary endpoints. Survival was analysed using the Kaplan-Meier method. Prognostic factors were evaluated using univariate and multivariate Cox regression analyses. Results Thirty-seven patients underwent CRS and HIPEC during the study period. The mean Peritoneal Cancer Index (PCI) was 17.2, and complete cytoreduction (CC-0/1) was achieved in 34 patients (91.9%). Major postoperative complications (Clavien-Dindo grade III–IV) occurred in seven patients (18.9%), while no 30-day postoperative mortality was observed. After a median follow-up of 68 months, the estimated 5-year and 10-year overall survival rates were 91.9% and 83.7%, respectively. Patients with a PCI ≤12 demonstrated significantly better overall survival than those with a PCI > 12 (log-rank p = 0.028). Multivariable analysis identified achievement of complete cytoreduction (CC-0/1) and elevated preoperative Carbohydrate Antigen 19-9 (CA19-9) as independent prognostic factors for overall survival. Conclusions CRS combined with HIPEC provides excellent long-term oncological outcomes with acceptable morbidity for patients with PMP when performed in a specialized national referral centre. Complete cytoreduction remains the principal determinant of survival, while preoperative CA19-9 provides additional prognostic information. These findings support continued centralization of PMP treatment for this rare disease.
Abstract Background Head computed tomography (CT) is the gold standard imaging modality for the evaluation of head injury. Skull radiography is no longer recommended in current guidelines due to its limited diagnostic value. Despite this, skull X-ray continues to be used in clinical practice. This study aimed to evaluate the diagnostic performance of skull X-ray and its association with intracranial injury. Patients and methods We conducted a retrospective study of 12,392 patient encounters with head injury at a single centre between 2018 and 2023. We analysed imaging utilization and findings. Diagnostic performance of skull X-ray was assessed in 759 cases where both X-ray and CT were performed. CT served as the reference standard. Sensitivity, specificity, predictive values, and associations with intracranial haemorrhage were calculated. Results Most X-rays were without a fracture (97.0 %). Skull X-ray demonstrated low sensitivity (43.6 %) and high specificity (91.4 %) for detecting skull fractures. Intracranial haemorrhage was present in 13.3 % of cases and occurred in 11.2 % of patients without a fracture on X-ray. Notably, 14.2 % of all CT scans (441 of 3,103) showed haemorrhage without fracture. Fracture on X-ray was associated with increased risk of intracranial haemorrhage (Odds Ratio [OR] 2.85, 95 % Confidence Interval [CI] 1.74–4.68). Clinically significant traumatic brain injury (csTBI) occurred in 17 of 759 encounters (2.2 %), with 12 admissions to intensive care unit, 10 neurosurgical interventions and 8 deaths after head injury. However, the association was not statistically significant (OR 2.64, 95 % CI 0.91–7.67, p = 0.075). Conclusions Skull radiography has limited diagnostic value, fails to detect intracranial injury and may provide false reassurance in a clinical setting. CT remains the preferred imaging modality, and routine use of skull X-ray should be reconsidered.
Abstract Background To compare voice quality in patients undergoing the most conservative transoral laser microsurgery (TLM) types classified as type I (subepithelial mucosal resection), versus complete removal of the vocal ligament and/ or part of the vocal muscle (type II/III cordectomy). Patients and methods Between 2021 and 2024, 65 patients with limited, clinically suspicious vocal fold lesions were included in a single-centre, prospective longitudinal study. Among them, 29 were diagnosed with high-grade intraepithelial neoplasia or early-stage glottic carcinoma (Tis/T1a) and were treated with TLM. Patients were divided into two groups: Group 1 (n = 13) included patients after type I cordectomy, and Group 2 (n = 16) included patients after type II/III cordectomy. Subjective and objective voice outcomes were assessed pre-treatment and at 1, 3, and 12 months post-treatment. Results At 12 months, both groups demonstrated comparably favourable subjective voice outcomes, although recovery was slower in Group 2. Perceptual analysis revealed poorer voice quality up to 6 months, followed by improvement in both groups at 12 months. Videostroboscopy showed progressive improvement in vibratory function only in Group 1. Acoustic measures in Group 1 demonstrated normalisation of F0 and the s/z ratio, while jitter and shimmer remained relatively stable and mean intensity remained unchanged. In Group 2, jitter, shimmer, VTI, and the s/z ratio remained elevated at 12 months, with more frequent scarring and presence of muscle tension dysphonia. Conclusions Objective voice measures demonstrated faster postoperative recovery in Group 1, whereas subjective voice outcomes improved substantially in both groups by 12 months.
BACKGROUND:Iodine is an essential component of thyroid hormones. Therefore, sufficient iodine intake is important for adequate thyroid function. Measuring the urinary iodine concentration (UIC) is the recommended method for assessing population iodine intake, but it has certain drawbacks. In addition to urine, iodine is also excreted into saliva. Therefore, the aim of our work was to determine whether salivary iodine concentration (SLIC) measurement could replace UIC measurements, even a gold standard, urinary iodine excretion (UIE) in the 24-hour urine. We also evaluated the influence of saliva collection time on SLIC measurements. SUBJECTS AND METHODS:We invited adult volunteers who first provided 24-hour urine and saliva samples collected on the same day at home, strictly according to the protocol. UIC and SLIC before and after meals were measured using the Sandell-Kolthoff method, comparable to inductively coupled plasma mass spectrometry. RESULTS:The study included 104 healthy participants from whom all biological samples were completely collected. Importantly, none of them was taking thyroid medication or iodine supplements and all were without thyroid disease. A very good correlation of SLIC values at 60 and 120 min after the first and second meal and 30 min after the second, third, and fourth meals with UIE was observed (P>0.05). CONCLUSIONS:We found an excellent correlation between SLIC values and UIE, where the SLIC value depends on the sampling timing and/or number of meals. SLIC measurement could replace UIE measurement and represents an important and possible new biomarker for assessing iodine intake.
BACKGROUND:Electrochemotherapy (ECT) can be performed on tumors in patients that precedes tumor irradiation or on recurrent tumors after tumor irradiation. In this study we evaluated the feasibility, safety and effectiveness of the combined ECT and tumor irradiation (radiotherapy, RT) on different tumors in the head and neck region. PATIENTS AND METHODS:For the present cohort analysis, patients were selected from the Insp-ECT database, based on the following criteria: presence of head and neck lesions of any histological origin, treatment with both ECT and RT in any sequence, and a maximum interval of 12 months between the two treatments. The patients were treated with ECT followed by RT (ECT → RT) or RT followed by ECT (RT → ECT), in both cases because the first treatment resulted in incomplete response or subsequent relapse. In the case of ECT → RT the meantime interval was 5.7 months and in the case of RT → ECT 7.6 months. The minimal time interval between the treatments was 1 month. RESULTS:Treatment with ECT with bleomycin was feasible in all patients, treated either before or after RT. Included were 37 patients with the head and neck lesions. The combined treatment was performed predominantly on older population of patients with the age range from 50 to 96 years, median over 80 years. Importantly, in the group ECT → RT the major reason for RT was partial response (67%) after ECT. While, in the RT → ECT group the major reason for subsequent ECT was 58% of stable or progressive disease (failure to treatment). In both groups local symptoms decreased, like ulceration, odour and suppuration of tumors. In the ECT → RT group, the short-term response after 2 months was high, with 89% objective responses. In contrast, the RT → ECT group had a significantly lower rate, with 58% objective responses. At 24-month progression free survival (PFS) was 68% in the ECT → RT group and 20% in the RT → ECT group (p = 0.0101). The overall progression free survival Kaplan-Meier curves also differed significantly (log-rank p = 0.0232). CONCLUSIONS:The combined treatment of ECT and RT is feasible, safe, and effective in elderly patients. The findings suggest that ECT may have particular value as a neoadjuvant treatment before RT, especially for bulky, ulcerated, or symptomatic lesions in this population.
