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Article ; Online: Elective open "Shield Tracheostomy" in patients with COVID-19.

Šifrer, Robert / Benedik, Janez / Aničin, Aleksandar

European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery

2021 Volume 279, Issue 2, Page(s) 891–897

Abstract: Purpose: To prevent the consequences of long-term endotracheal intubation, patients undergo tracheostomies. However, as COVID-19 is highly contagious, its existence has made the tracheostomy a high-risk procedure. Tracheostomy procedures must, therefore, ...

Abstract	Purpose: To prevent the consequences of long-term endotracheal intubation, patients undergo tracheostomies. However, as COVID-19 is highly contagious, its existence has made the tracheostomy a high-risk procedure. Tracheostomy procedures must, therefore, be adjusted for safety reasons. The aim is to present the adjustments that should be made to the surgical technique. Methods: Both the medical charts and surgical reports of patients with COVID-19 who were subjected to elective open tracheostomies were reviewed. Results: The retrospective study included 25 patients. Our adjustments include the timing of tracheostomies, ideally putting them at 21 days after the onset of COVID-19, the advancement of an endotracheal tube to 26-28 cm from the upper-alveolar ridge, surgery being carried out in the intensive care unit with appropriately modified positions of the patient and providers, tracheo-cutaneous sutures, and intentionally making the small tracheal flap and the tracheal window the same shape as a medieval shield. Conclusions: A tracheostomy performed in this way is now referred to as the Shield Tracheostomy. Further improvements to the surgical technique are expected in the future.
MeSH term(s)	COVID-19 ; Humans ; Intubation, Intratracheal ; Retrospective Studies ; SARS-CoV-2 ; Tracheostomy
Language	English
Publishing date	2021-04-21
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1017359-6
ISSN	1434-4726 ; 0937-4477
ISSN (online)	1434-4726
ISSN	0937-4477
DOI	10.1007/s00405-021-06820-7
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Article ; Online: Kirugija glave in vratu med pandemijo covida-19

Sara Bitenc Zore / Robert Šifrer / Ajda Mavrič / Aleksandar Aničin

Zdravniški Vestnik, Vol 91, Iss 1-2, Pp 46-

2022 Volume 56

Abstract: Kirurgija glave in vratu med pandemijo covida-19 je za zdravstveni sistem velik izziv. Pred kirurškimi posegi je potrebna ustrezna priprava in poznavanje vseh možnosti zdravljenja, da bolnik in zdravstveni delavci ne tvegajo okužbe. Treba je odložiti vse ...

Abstract	Kirurgija glave in vratu med pandemijo covida-19 je za zdravstveni sistem velik izziv. Pred kirurškimi posegi je potrebna ustrezna priprava in poznavanje vseh možnosti zdravljenja, da bolnik in zdravstveni delavci ne tvegajo okužbe. Treba je odložiti vse posege, katerih odložitev ne ogroža bolnikovega zdravja. Operacijske posege glede na nujnost delimo v tri skupine – v prvo skupino sodijo urgentni, neodložljivi posegi, v drugo skupino posegi, ki jih lahko odložimo za največ štiri tedne, in v tretjo skupino posegi, katerih odložitev za šest do osem tednov ne vpliva na izid zdravljenja. Pred predvideno operacijo je treba ugotoviti status okužbe bolnika z virusom SARS-CoV-2, razen ob urgentnih posegih, ki jih opravimo ne glede na status okužbe bolnika. Kirurški posegi glave in vratu se med seboj razlikujejo glede na možnost prenosa okužbe z virusom SARS-CoV-2 s pozitivnega bolnika na zdravstvenega delavca; pri tem upoštevamo predvsem verjetnost tvorbe aerosola med posegom. Med posege največjega tveganja sodijo endoskopske preiskave zgornjih dihal in prebavil ter žlez slinavk in operacije v tem področju, ki prekinejo sluznice. Te so: traheotomija, laringektomija, faringektomija, operacija raka ustne votline, transoralna laserska mikrokirurgija, transoralna robotska kirurgija. V skrbi za zdravje zdravstvenega osebja in bolnikov je med kirurškimi posegi nujna dosledna uporaba osebne varovalne opreme ne glede na okuženost bolnika.
Keywords	virus sars-cov-2 ; triaža ; rak glave in vratu ; osebna varovalna oprema ; diagnosticiranje ; zdravljenje ; Medicine ; R
Language	English
Publishing date	2022-02-01T00:00:00Z
Publisher	Slovenian Medical Association
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Sialendoskopija v času pred, med in po pandemiji covida-19

Aleksandar Aničin, Doc. Dr. / Robert Šifrer, Doc. Dr. / Jure Urbančič, As.

Zdravniški Vestnik, Vol 91, Iss 1-2, Pp 40-

2022 Volume 45

Abstract: Sialendoskopske tehnike predstavljajo novo paradigmo, ki je bistveno spremenila zdravljenje zastojne bolezni žlez slinavk. Epidemija covida-19 predstavlja nov izziv za zdravstveni sistem sleherne države in postavlja na preizkušnjo številne, predvsem ... ...

Abstract	Sialendoskopske tehnike predstavljajo novo paradigmo, ki je bistveno spremenila zdravljenje zastojne bolezni žlez slinavk. Epidemija covida-19 predstavlja nov izziv za zdravstveni sistem sleherne države in postavlja na preizkušnjo številne, predvsem elektivne kirurške metode zdravljenja. Kirurški posegi v področju glave in vratu in še posebej v ustni votlini predstavljajo hudo tveganje za prenos covida-19. Pri izvajanju sialendoskopije oziroma sialendoskopsko asistirane operacije sta kirurška ter anesteziološka ekipa izpostavljeni slini in refleksom občutljivega anatomskega področja ust oziroma zgornjih dihal in prebavil. Ostaja vprašanje, kolikšno je tveganje glede na fazo operacije, vrsto anestezije, uporabljeno osebno varovalno opremo ter trenutno epidemiološko situacijo covida-19. V času pandemije covida-19 smo na Kliniki za otorinolaringologijo in cervikofacialno kirurgijo Ljubljana izvajali le nujne, kasneje pa tudi elektivne sialendoskopske in sialendoskopsko asistirane posege. Menimo, da je v času obvladljive epidemiološke situacije sialendoskopska kirurgija ob upoštevanju indikacij in zaščitnih ukrepov lahko varna za bolnika in izvajalca.
Keywords	žleze slinavke ; endoskopija ; virus sars-cov-2 ; varnost ; epidemija ; Medicine ; R
Language	English
Publishing date	2022-02-01T00:00:00Z
Publisher	Slovenian Medical Association
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: The Incidence and the Risk Factors for Pharyngocutaneous Fistula following Primary and Salvage Total Laryngectomy.

Šifrer, Robert / Strojan, Primož / Tancer, Ivana / Dolenc, Maja / Fugina, Simon / Zore, Sara Bitenc / Aničin, Aleksandar

Cancers

2023 Volume 15, Issue 8

Abstract: The pharyngocutaneous fistula (PCF) is the most common complication following a total laryngectomy (TL) with a wide range of incidence and various potential risk factors. The aim was to analyse the incidence and potential risk factors for PCF formation ... ...

Abstract	The pharyngocutaneous fistula (PCF) is the most common complication following a total laryngectomy (TL) with a wide range of incidence and various potential risk factors. The aim was to analyse the incidence and potential risk factors for PCF formation in a large study set collected over a longer period of time. In the retrospective study at the Department of Otorhinolaryngology and Cervicofacial Surgery of Ljubljana, 422 patients who were treated for head and neck cancer by TL between 2007 and 2020 were included. The comprehensive clinicopathologic data were collected including potential risk factors related to the patient, disease, surgical treatment and post-operative period for the development of fistulae. The patients were categorized into a group with the fistula (a study group) and one without it (a control group). The PCF then developed in 23.9% of patients. The incidence following a primary TL was 20.8% and 32.7% following salvage TL (
Language	English
Publishing date	2023-04-12
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers15082246
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Article ; Online: The diagnostic value of perpendicular vascular patterns of vocal cords defined by narrow-band imaging.

Šifrer, Robert / Šereg-Bahar, Maja / Gale, Nina / Hočevar-Boltežar, Irena

2020 Volume 277, Issue 6, Page(s) 1715–1723

Abstract: Purpose: According to the classification of glottic lesions by narrow-band imaging (NBI) proposed by the European Laryngological Society (ELS), lesions without perpendicular patterns are benign, while wide- and narrow-angled perpendicular lesions ... ...

Abstract	Purpose: According to the classification of glottic lesions by narrow-band imaging (NBI) proposed by the European Laryngological Society (ELS), lesions without perpendicular patterns are benign, while wide- and narrow-angled perpendicular lesions include both papilloma and carcinoma/high-grade lesions, respectively. The purpose of the study was to investigate the effectiveness of the ELS classification. Methods: One hundred and forty four patients with glottic lesions underwent microlaryngoscopy with NBI. The affected vocal cords (arm A) were histologically analysed. The unaffected vocal cords (arm B) were not histologically analysed and were considered to be true negatives if no suspicious changes appeared during the follow-up. The vocal cords from arm A were categorised into three groups-those with a benign disease (papilloma excluded), those with a carcinoma/high-grade lesion and those with papilloma. The ratio of vascular patterns was determined and the groups were statistically compared using the Chi-square test. Results: Perpendicular patterns were identified only in 9.3% (9/97) of those in the benign group (without papilloma). Wide-angled patterns were mainly identified in cases of papilloma (80%, 12/15), while the narrow-angled ones were mostly identified in cases of carcinoma and high-grade lesions (96.2%, 76/79) (P < 0.001). The sensitivity, specificity, positive and negative predictive values and accuracy were 98%, 95%, 88%, 99% and 95%, respectively. Conclusion: The ELS classification of vocal cord lesions by NBI is effective in differentiating between carcinoma/high-grade lesions and papilloma and the remaining benign lesions of the vocal cords.
MeSH term(s)	Humans ; Laryngeal Neoplasms/diagnostic imaging ; Laryngoscopy ; Narrow Band Imaging ; Sensitivity and Specificity ; Vocal Cords/diagnostic imaging
Language	English
Publishing date	2020-02-28
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1017359-6
ISSN	1434-4726 ; 0937-4477
ISSN (online)	1434-4726
ISSN	0937-4477
DOI	10.1007/s00405-020-05864-5
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Article ; Online: Elektivna odprta traheotomija pri bolniku s covidom-19

Robert Šifrer, Doc. Dr. / Črtomir Iglič

Zdravniški Vestnik, Vol 89, Iss 11-12, Pp 680-

2020 Volume 691

Abstract: Traheotomija in postopki, povezani z njo pri bolniku s covidom-19, se ocenjujejo kot visoko tvegani za prenos virusa SARS-CoV-2 na ekipo, ki poseg opravlja, in osebje, ki po operaciji skrbi za bolnika. Namen članka je prikazati prilagoditev postopkov ... ...

Abstract	Traheotomija in postopki, povezani z njo pri bolniku s covidom-19, se ocenjujejo kot visoko tvegani za prenos virusa SARS-CoV-2 na ekipo, ki poseg opravlja, in osebje, ki po operaciji skrbi za bolnika. Namen članka je prikazati prilagoditev postopkov elektivne odprte kirurške traheotomije pri dolgotrajno intubiranih bolnikih zaradi okužbe z virusom SARS-CoV-2. Pripravljen je bil osnovni protokol za elektivno odprto kirurško traheotomijo pri bolnikih s covidom-19, ki se začne pri multidisciplinarni postavitvi indikacije za traheotomijo za vsakega bolnika posebej. Za razliko od običajnih okoliščin se traheotomija pri bolniku s covidom-19 izvede kasneje, in sicer v sobi intenzivne enote in ob uporabi ustrezne osebne varovalne opreme. Svetuje se vzpostavitev tima za covid-19, sestavljenega iz izkušenega osebja, ki operacijo izvede varno, hitro in zanesljivo. Opisujemo kirurško izvedbo traheotomije, pri kateri je bistvenega pomena, prvič, usklajeno in specifično sodelovanje kirurške in anesteziološke ekipe po prej dogovorjenem postopku, in, drugič, odsotnost in izogibanje uporabi pripomočkov in postopkov, ki sprožajo nastanek aerosola. Pod podobnimi pogoji se nato opravljata tudi skrb za bolnika po operaciji in reševanje morebitnih zapletov po njej. Pomembno je, da je mešiček pri bolniku s covidom-19 stalno napihnjen in da se trahealna kanila menja čim manjkrat in čim kasneje.
Keywords	dihalna pot ; sars-cov-2 ; aerosol ; tim za covid-19 ; koordinacija ; Medicine ; R
Language	English
Publishing date	2020-12-01T00:00:00Z
Publisher	Slovenian Medical Association
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Nova možnost konzervativnega zdravljenja hilozne fistule po disekciji na vratu z oktreotidom

Tomaž Sindičič / Aleksandar Aničin, Doc. Dr. / Robert Šifrer, Doc. Dr.

Zdravniški Vestnik, Vol 90, Iss 9-10, Pp 505-

2021 Volume 511

Abstract: Eden od zapletov disekcije na vratu je hilozna fistula. Največkrat nastane zaradi poškodbe torakalnega voda. Vidi se oteklina nizko na vratu levo. Iz rane lahko izteka tekočina, ki je prozorna ali mlečne barve, kar je odvisno od vsebnosti maščob. Cilj ... ...

Abstract	Eden od zapletov disekcije na vratu je hilozna fistula. Največkrat nastane zaradi poškodbe torakalnega voda. Vidi se oteklina nizko na vratu levo. Iz rane lahko izteka tekočina, ki je prozorna ali mlečne barve, kar je odvisno od vsebnosti maščob. Cilj zdravljenja je popolno prenehanje izcejanja tekočine. Od konzervativnih metod se najpogosteje uporablja prehrana z manj maščobami, s srednje dolgimi trigliceridi, brez maščob, kompresijsko povijanje in v zadnjem času oktreotid, ker zavira tvorbo hilozne tekočine. Zato se fistula lažje zaceli. Opisujemo dva bolnika s hilozno fistulo na vratu, pri katerih smo ob konzervativnih ukrepih uspešno uporabili oktreotid. Iz literature smo povzeli podatke o zdravljenju hiloznih fistul po disekciji na vratu z oktreotidom. Zdravljenje z oktreotidom v kombinaciji z že ustaljenimi konzervativnimi postopki zapre večino hiloznih fistul na vratu brez kirurške revizije.
Keywords	hilozna tekočina ; torakalni vod ; zaplet operacije ; zdravljenje ; analog somatostatina ; Medicine ; R
Language	English
Publishing date	2021-10-01T00:00:00Z
Publisher	Slovenian Medical Association
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Otočni reženj supraklavikularne arterije – dodatna možnost za rekonstrukcijo vrzeli na glavi in vratu

Robert Šifrer / Iztok Fošnarič / Jošt Paučič / Aleksandar Aničin

Zdravniški Vestnik, Vol 88, Iss 7-8, Pp 360-

2019 Volume 369

Abstract: Obstaja veliko možnosti za kritje vrzeli po onkološki kirurgiji na glavi in vratu. Najpogosteje se uporablja prosti fasciokutani radialni reženj, prosti anterolateralni stegenski reženj in vezani mišičnokožni reženj, t. i. pectoralis maior. Fasciokutani ... ...

Abstract	Obstaja veliko možnosti za kritje vrzeli po onkološki kirurgiji na glavi in vratu. Najpogosteje se uporablja prosti fasciokutani radialni reženj, prosti anterolateralni stegenski reženj in vezani mišičnokožni reženj, t. i. pectoralis maior. Fasciokutani otočni reženj supraklavikularne arterije (SCAIF) je vsestranski reženj s področja nad ključnico in ramena. Baziran je na supraklavikularni arteriji, katere odcepišče od žile arteria transversa colli se nahaja v trikotniku na vratu, ki ga omejuje posteriorni rob sternokleidomastoidne mišice s ključnico in z žilo, poimenovano vena iugularis externa. Dolžina 26 cm, širina 6–7 cm in lok obrata omogočajo kritje kožnih vrzeli lateralno na vratu in na parotidnem področju ter v izjemnih primerih kritje temporalnih vrzeli. Na drugi strani je SCAIF uporaben za rekonstrukcijo vrzeli na sluznici ustne votline, žrela, požiralnika in za kritje fistul po operaciji. Opisujemo primer uporabe SCAIF pri bolnici z lokalno napredovalim karcinomom zunanjega sluhovoda in pri bolniku z obsežno metastazo v obušesni slinavki. Dvig SCAIF je kirurško nezahteven in hiter. SCAIF je zanesljiv, varen, ima malo zapletov in dobre funkcionalne in estetske rezultate, zato je široko uporaben za rekonstrukcijo različnih mehkotkivnih vrzeli na glavi in vratu.
Keywords	rak ; režnji ; rekonstrukcija ; supraklavikularna arterija ; supraklavikularni reženj ; Medicine ; R
Language	English
Publishing date	2019-10-01T00:00:00Z
Publisher	Slovenian Medical Association
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Neuroendocrine Carcinoma of the Larynx and Pharynx: A Clinical and Histopathological Study.

Strojan, Primož / Šifrer, Robert / Ferlito, Alfio / Grašič-Kuhar, Cvetka / Lanišnik, Boštjan / Plavc, Gaber / Zidar, Nina

Cancers

2021 Volume 13, Issue 19

Abstract: Neuroendocrine carcinomas (NECs) of the head and neck are rare and the experience scanty. The Cancer Registry of Slovenia database was used to identify cases of laryngeal and pharyngeal NECs diagnosed between 1995-2020. Biopsies were analyzed for the ... ...

Abstract	Neuroendocrine carcinomas (NECs) of the head and neck are rare and the experience scanty. The Cancer Registry of Slovenia database was used to identify cases of laryngeal and pharyngeal NECs diagnosed between 1995-2020. Biopsies were analyzed for the expression of standard neuroendocrine markers (synaptophysin, chromogranin, CD56), INSM1, Ki-67, p16, and PD-L1 (using the combined positive score, CPS). In situ hybridization for human papillomavirus (HPV) and Epstein-Barr virus (EBV) was performed. Twenty patients (larynx, 12; pharynx, 8) were identified. One tumor was well differentiated (WD), five were moderately differentiated (MD), and 14 were poorly differentiated (PD). Disease control was achieved solely by surgery in 4/4 MD/PD T1-2N0-1 tumors. Eight patients died of the disease, seven of which were due to distant metastases. All three traditional markers were positive in 11/17 NECs and the INSM1 marker in all 20 tumors. Two of fourteen p16-positive tumors were HPV-positive, but all three nasopharyngeal NECs were EBV-negative. Three tumors had CPSs ≥ 1. In conclusion, INSM1 was confirmed to be a reliable marker of neuroendocrine differentiation. Except in WD and early-stage MD/PD tumors, aggressive multimodal therapy is needed; the optimal systemic therapy remains to be determined. p16, HPV, and EBV seem to bear no prognostic information.
Language	English
Publishing date	2021-09-27
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers13194813
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Article ; Online: Consequences of Stapes Surgery on Tongue Morphological Characteristics in Narrow Band Imaging, Gustatory Function and General Sensation

Nina Božanić Urbančič / Domen Vozel / Nejc Steiner / Manja Hribar / Iztok Fošnarič / Robert Šifrer / Jure Urbančič / Saba Battelino

Applied Sciences, Vol 12, Iss 3248, p

A Prospective Tertiary Center Study

2022 Volume 3248

Abstract: 1) Background: Chorda tympani (CT) manipulation during stapes surgery affects its functions. We hypothesized that this alters tongue morphology and sensory functions. (2) Methods: Patients undergoing stapes surgery were tested 1 day preoperatively, 1 ... ...

Abstract	(1) Background: Chorda tympani (CT) manipulation during stapes surgery affects its functions. We hypothesized that this alters tongue morphology and sensory functions. (2) Methods: Patients undergoing stapes surgery were tested 1 day preoperatively, 1 and 6 months postoperatively. Narrow band imaging contact endoscopy (NBI) was used to determine the number of fungiform papillae (N papillae ) and the total score of blood vessel morphology (NBI total ). The taste was tested with taste strips. General sensation was tested with a static two-point discrimination. Tests were performed on ipsilateral and contralateral side of the tongue. (3) Results: 52 otosclerosis patients were included in the study. There was a statistically significant decrease of NBI total ( p = 0.005), N papillae ( p = 0.009), sensation of sweet ( p = 0.003), salty ( p = 0.035), sour ( p = 0.036), and bitter taste ( p = 0.013) within the test side during the follow-up. A statistically significant impact on presence of dysgeusia for sweet was found 1 month postoperatively ( p < 0.005). Postoperative decrease in two-point discrimination score did not reach a statistical significance ( p = 0.056). (4) Conclusions: CT manipulation affects fungiform papillae density, vascular patterns and taste sensation. The general sensation of the tongue is not influenced by CT manipulation.
Keywords	hearing loss ; facial nerve ; taste buds ; otologic surgical procedures ; microscopy ; endoscopes ; Technology ; T ; Engineering (General). Civil engineering (General) ; TA1-2040 ; Biology (General) ; QH301-705.5 ; Physics ; QC1-999 ; Chemistry ; QD1-999
Subject code	616
Language	English
Publishing date	2022-03-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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