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Pascal Kingah, Nasser Alzubaidi, Jihane Zaza Dit Yafawi, Emad Shehada, Khaled Alshabani and Ayman O. Soubani

Abstract

Purpose: Several studies show conflicting results regarding the prognosis and predictors of the outcome of critically ill patients with a solid malignancy. This study aims to determine the outcome of critically ill patients, admitted to a hospital, with a solid malignancy and the factors associated with the outcomes.

Methods and Materials: All patients with a solid malignancy admitted to an intensive care unit (ICU) at a tertiary academic medical center were enrolled. Clinical data upon admission and during ICU stay were collected. Hospital, ICU, and six months outcomes were documented.

Results: There were 252 patients with a solid malignancy during the study period. Urogenital malignancies were the most common (26.3%) followed by lung cancer (23.5%). Acute respiratory failure was the most common ICU diagnosis (51.6%) followed by sepsis in 46%. ICU mortality and hospital mortality were 21.8% and 34.3%. Six months mortality was 38.4%. Using multivariate analysis, acute kidney injury, OR 2.82, 95% CI 1.50-5.32 and P=0.001, use of mechanical ventilation, OR 2.67 95% CI 1.37 – 5.19 and P=0.004 and performance status of ≥2 with OR of 3.05, 95% CI of 1.5-6.2 and P= 0.002 were associated with hospital mortality. There were no differences in outcome between African American patients (53% of all patients) and other races.

Conclusion: This study reports encouraging survival rates in patients with a solid malignancy who are admitted to ICU. Patients with a poor baseline performance status require mechanical ventilation or develop acute renal failure have worse outcomes.

Open access

Andra Virlan, Nicoleta Schileru, Amalia Neagu and Claudiu Manea

Abstract

A 40-year-old female patient presented to our clinic for bilateral nasal obstruction, anteroposterior mucopurulent rhinorrhea, recurrent micro-epistaxis, anosmia, left otodynia, fever and sweating. The ENT findings and CT scan detected a septal tumor with predominant extension in the left nostril, with erosive character of the osteo-cartilaginous septal structure, without sinusal involvement and left lateralcervical adenopathy. Resection of the entire septal tumor formation was performed. The histopathological outcome revealed non-Hodgkin’s small-type NK/T extranodal nasal-type lymphoma – immunohistochemical tests confirmed histogenesis.

Open access

Paskaramoorthy Sasitharan, Nor Idayu Mohd Yusof and Kugan Varatha Raju

Abstract

Extramedullary plasmacytoma is a rare neoplasm characterized by monoclonal proliferation of plasma cells. It is most often located in the head and neck region. Extramedullary Plasmacytomas are more predominant in males who are in the 5th – 6th decade. In this report, this patient, who is a young female, presented to our clinic with history of intermittent nasal obstruction for the past year. She was diagnosed with extramedullary plasmacytoma and was subjected to radiotherapy. The clinical and histopathologic findings of plasmacytoma are discussed. In order to exclude systemic involvement, a systematic approach using clinical, laboratory and radiologic investigations was performed. Extramedullary plasmacytoma of the nasal cavity is rare and should be considered in the differential diagnosis of nasal cavity masses, especially in the young age group.

Open access

Gurmeet Ram Rahim, Neha Gupta and Gaurav Aggarwal

Open access

Gabriela Musat, Alina Anghel, Lucia Radu and Roxana Decusara

Abstract

BACKGROUND. Vestibular disorders are a group of widely spread diseases that have as a common denominator the disturbance of the equilibrium system. The assessment of vestibular disorders consists in a complex examination of the patient including a thorough anamnesis, a rigorous clinical examination and multiple functional explorations.

OBJECTIVE. To asses weather there is a correlation between the data obtained in posturography and those obtained in the videonystagmography in patients with peripheral vestibular disorders.

MATERIAL AND METHODS. Collecting data from the observation sheets of patients diagnosed with peripheral vestibular syndrome and examined in the Department of Otorhinolaryngology of the “Sfanta Maria” Hospital in Bucharest over a period of 18 months.

RESULTS. We analyzed a number of 97 cases of patients diagnosed with peripheral vestibular disorder. A large number of patients (49) had correlated changes in the caloric tests and also in the posturography. A second group of patients (43) had changes in caloric tests but with no changes in posturography. The third group of 5, paradoxically, had a vestibular deficiency in posturography associated with normal caloric reactivity.

CONCLUSION. The results obtained with the videonystagmography are correlated with those of the caloric and rotational videonystagmographic tests in the case of acute vestibular diseases. In chronic vestibular diseases, it is possible to find caloric vestibular paresis in the presence of a normal posturography. The “vestibular omission” is a phenomenon in which the patient does not use the vestibular input of a normal labyrinth with caloric and rotary tests within normal limits. As no vestibular examination can be considered as selfstaging diagnosis, we always have to establish the final diagnosis correlating the results of all the tests available.

Open access

Catherine D. Tobin, Tamas A. Szabo, Bethany J. Wolf, Kathryn H. Bridges, Tod A. Brown, Erick M. Woltz and Robert D. Warters

Abstract

Background and Aims: Manual bag mask ventilation is a life saving skill. An investigation was made to compare two different facemasks used in bag mask ventilation, the standard and the novel Tao face mask, and evaluate the ability of novices to achieve adequate tidal volume. Methods: The study design was a crossover trial, which randomized forty medical students with no previous airway experience to learn bag mask ventilation with the standard mask and the Tao face mask. Primary outcome measures were mean and median tidal volume per mask, and secondary measures were hand area, age, gender, and order of mask usage. Results: Medical students who used the Tao mask first achieved significantly more tidal volume than those who used the standard mask first (p = 0.002). However, when comparing face masks that were used second, the tidal volume did not differ significantly between the two masks (p = 1.000). Greater tidal volume was achieved on the second attempt relative to the first attempt with each mask. There was significantly more tidal volume achieved with greater hand size with the standard mask, whether it was used first or second (p < 0.001 and p = 0.012 respectively). Greater hand size was associated with greater tidal volume in the Tao mask also, but only when used first (p < 0.001). When first attempting bag mask ventilation, inexperienced students achieved greater tidal volume with the Tao Mask. The results also suggest that hand size matters less when using the Tao Mask. Conclusion: When first attempting bag mask ventilation inexperienced students achieved greater tidal volume with the Tao Mask. The results also suggest that hand size matters less when using the Tao mask.

Open access

Mircea Gabriel Mureșan, Ioan Alexandru Balmoș, Iudita Badea and Ario Santini

Abstract

Despite the significant development and advancement in antibiotic therapy, life-threatening complication of infective diseases cause hundreds of thousands of deaths world. This paper updates some of the issues regarding the etiology and treatment of abdominal sepsis and summaries the latest guidelines as recommended by the Intra-abdominal Infection (IAI) Consensus (2017). Prognostic scores are currently used to assess the course of peritonitis. Irrespective of the initial cause, there are several measures universally accepted as contributing to an improved survival rate, with the early recognition of IAI being the critical matter in this respect. Immediate correction of fluid balance should be undertaken with the use of vasoactive agents being prescribed, if necessary, to augment and assist fluid resuscitation. The WISS study showed that mortality was significantly affected by sepsis irrespective of any medical and surgical measures. A significant issue is the prevalence of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae in the clinical setting, and the reported prevalence of ESBLs intra-abdominal infections has steadily increased in Asia. Europe, Latin America, Middle East, North America, and South Pacific. Abdominal cavity pathology is second only to sepsis occurring in a pulmonary site. Following IAI (2017) guidelines, antibiotic therapy should be initiated as soon as possible after a diagnosis has been verified.

Open access

Gabriel Alexandru Popescu, Tivadar Bara and Paul Rad

Abstract

Abdominal Compartment Syndrome (ACS), despite recent advances in medical and surgical care, is a significant cause of mortality. The purpose of this review is to present the main diagnostic and therapeutic aspects from the anesthetical and surgical points of view. Intra-abdominal hypertension may be diagnosed by measuring intra-abdominal pressure and indirectly by imaging and radiological means. Early detection of ACS is a key element in the ACS therapy. Without treatment, more than 90% of cases lead to death and according with the last reports, despite all treatment measures, the mortality rate is reported as being between 25 and 75%. There are conflicting reports as to the importance of a conservative therapy approach, although such an approach is the central to treatment guidelines of the World Society of Abdominal Compartment Syndrome, Decompressive laparotomy, although a backup solution in ACS therapy, reduces mortality by 16-37%. The open abdomen management has several variants, but negative pressure wound therapy represents the gold standard of surgical treatment.