We present a rare case of combined high bifurcation of the common carotid artery, anomalous origin of the ascending pharyngeal artery and unusual branching pattern of the external carotid artery. The right common carotid artery bifurcated at the level between the second and the third cervical vertebrae, giving rise to the ascending pharyngeal artery just below the bifurcation. The right external carotid artery branched directly at its origin into the superior thyroid, lingual and occipital arteries and the distal part of the external carotid artery. The latter gave rise to the right facial artery and finally bifurcated into the maxillary and superficial temporal arteries. The right posterior auricular artery arose from the right occipital artery. The finding was unilateral and other vascular anomalies were not observed. The embryogenesis of such a combination of anomalies is not clear, but the anatomic consequences may have important clinical implications.

Andrea et al. were the first to use contact endoscopy in the diagnosis of laryngeal disease, in 1995. This method enables in vivo microscopy of laryngeal mucosa. In the present study, comparison of contact endoscopy with frozen section histopathology was performed in 142 patients with various diseases of the larynx. Paraffin section histopathology diagnosed 70 benign lesions, 23 precancerous lesions and 49 malignant lesions. Frozen section histopathology showed a sensitivity of 89.8 per cent, a specificity of 98.9 per cent and an accuracy of 95.7 per cent (chi2 = 1.5; p = 0.18). Frozen histopathology diagnosed 45 malignant lesions, including one false positive and five false negative results. Contact endoscopy yielded a sensitivity of 79.59 per cent, a specificity of 100 per cent and an accuracy of 92.95 per cent (chi2 = 8.1; p = 0.002). All malignant lesions diagnosed by contact endoscopy were confirmed by histopathology; contact endoscopy failed to recognise malignant lesions in 10 patients. Contact endoscopy is preferable to frozen section histopathology as it is noninvasive, provides information on microscopic diagnosis and laryngeal lesion margins, and enables visualisation of the laryngeal mucosa microvasculature. The use of contact endoscopy along with frozen section histopathology improves diagnostic accuracy and allows for operative (or other) therapy to continue according to the results obtained.

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The clinical management and long-term outcome in lightning survivors with substantial ear damage treated at the Department of Otorhinolaryngology, University Hospital Split during the 1984-1999 period are reviewed. Results of clinical management and outcomes of lightning ear damage in 18 patients (mean age 35.3 +/- 5 years) were retrospectively analyzed. On admission, all patients complained of severe pain, tinnitus and hearing impairment. Otomicroscopy revealed tympanic membrane rupture in 12 patients. The active therapeutic approach included immediate otomicroscopy, aseptic aspiration toilet, and eversion of perforation edges. In all patients, the ruptures healed well, and restitution of the hearing function was achieved. Follow-up examination performed in 1999 (13.2 +/- 2.9 years later) in 11 patients (mean age 52.3 +/- 6.1 years) revealed an almost identical audiogram as on discharge from the hospital, however, neuropsychological testing revealed numerous sequelae. Tympanic injury caused by lightning should be actively treated. Lightning survivors require additional psychotherapeutic treatment.

Aim To determine the prognostic value of cell cycle regulators cyclin D1 and p27 for papillary thyroid carcinomas.Methods Analysis included 180 patients with papillary thyroid carcinoma who underwent surgery at Split University Hospital Center between 1999 and 2001. Clinical data were obtained from clinical charts and histopathology reports. Immunohistochemistry was performed on formalin-fixed, paraffin-embedded tissue by antibody p27 and cyclin D1. Quantification was based on the intensity and distribution of nuclear staining.Results Univariate analysis showed that sex (P = 0.019) and capsular invasion (P = 0.010) were significant predictors of lymph node metastases, whereas age (P = 0.96), histopathological variant (P = 0.075), size (P = 0.556) and multifocality (P = 0.131) were not. Univariate analysis also showed that overexpression of cyclin D1 (P < 0.001) and underexpression of p27 (P < 0.001) predicted lymph node metastases in papillary thyroid carcinomas. There was a significant correlation between cyclin D1 (P = 0.024) and p27 (P = 0.029) expression in two prognostic groups of low and high risk. Low risk group was cyclin D1 negative and p27 positive, whereas high risk group was cyclin D1 positive and p27 negative. Multivariate analysis confirmed that sex (P = 0.041), capsular invasion (P = 0.027), and p27 (P < 0.001) were strong independent predictors of lymph node metastases in the high-risk group.Conclusions Immunohistochemical analysis of p27 expression may be a valuable tool for identifying risk of lymph node metastases and more aggressive behavior of papillary thyroid carcinoma.