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Open access

Nuray Bayar Muluk

Abstract

OBJECTIVES. We reviewed the relationship between olfactory functions and Behçet’s disease (BD).

MATERIAL AND METHODS. We searched Pubmed, Google, Google Scholar and Proquest Cebtral Database with the key words of “olfactory”, “functions”, “smell”, “nasal” and “Behçet’s disease”.

RESULTS. Behçet’s disease influences the nasal mucosa. Nasal mucosal inclusion causes mucosal ulcers, pain, burning, nasal obstruction, epistaxis, nasal itching and dysosmia. Nasal cartilage deformity is also reported. The higher rate of comorbid chronic rhinosinusitis (CRS) in BD patients may likewise be because of the complex mechanism of the disease inclining the host tissues to bacterial infections. Olfactory functions may decrease in BD. Odor identification may be lower in patients BD.

CONCLUSION. An olfactory dysfunction may be seen in patients with BD. BD patients should be evaluated for the involvement of the olfactory function and may require treatment because of a malfunction of the olfactory system that influences the quality of life. Neurological involvement associated with BD might play a more important role in causing olfactory dysfunction than mucosal involvement.

Open access

Daniela Vrinceanu, Mihai Dumitru, Maria Sajin, Carmen Maria Salavastru and Adrian Costache

Abstract

BACKGROUND. Lymph node tuberculosis is a pathology with an increasing incidence and prevalence in middle income countries.

MATERIAL AND METHODS. We present a series of 4 cases with cervical lymph node tuberculosis. We review current principles of diagnosis and treatment from the perspective of the ENT surgeon in a tertiary university clinic.

RESULTS. In each case we underline diagnosis difficulties and treatment options. These cases presented management difficulties due to associated morbidities. All cases underwent surgical excision of the afflicted lymph nodes with subsequent microscopic confirmation of tuberculosis. We illustrate key concepts leading to the microscopy diagnosis of lymph node tuberculosis.

CONCLUSION. There are various surgical incidents and accidents that the young surgeon must be aware of when approaching neck tuberculous lymph nodes. Further referral of the patient for long-term tuberculosis treatment is mandatory. All patients were supervised for a minimum of 1 year after the initial diagnosis and treatment with no sign of recurrence. A close cooperation between the ENT surgeon, the infectious disease specialist and the pathologist is the key to an optimum approach to lymph node tuberculosis at the head and neck level.

Open access

Teodora Sorana Truta, Cristian Marius Boeriu, Marc Lazarovici, Irina Ban, Marius Petrişor and Sanda-Maria Copotoiu

Abstract

Introduction: Errors are frequent in health care and Emergency Departments are one of the riskiest areas due to frequent changes of team composition, complexity and variety of the cases and difficulties encountered in managing multiple patients. As the majority of clinical errors are the results of human factors and not technical in nature or due to the lack of knowledge, a training focused on these factors appears to be necessary. Crisis resource management (CRM), a tool that was developed initially by the aviation industry and then adopted by different medical specialties as anesthesia and emergency medicine, has been associated with decreased error rates.

The aim of the study: To assess whether a single day CRM training, combining didactic and simulation sessions, improves the clinical performance of an interprofessional emergency medical team.

Material and Methods: Seventy health professionals with different qualifications, working in an emergency department, were enrolled in the study. Twenty individual interprofessional teams were created. Each team was assessed before and after the training, through two in situ simulated exercises. The exercises were videotaped and were evaluated by two assessors who were blinded as to whether it was the initial or the final exercise. Objective measurement of clinical team performance was performed using a checklist that was designed for each scenario and included essential assessment items for the diagnosis and treatment of a critical patient, with the focus on key actions and decisions. The intervention consisted of a one-day training, combining didactic and simulation sessions, followed by instructor facilitated debriefing. All participants went through this training after the initial assessment exercises.

Results: An improvement was seen in most of the measured clinical parameters.

Conclusion: Our study supports the use of combined CRM training for improving the clinical performance of an interprofessional emergency team. Empirically this may improve the patient outcome.

Open access

Maria Oana Mărginean, Lorena Elena Meliț, Simona Mocanu and Vlăduț Săsăran

Abstract

Introduction: Upper gastrointestinal bleeding is an uncommon but possible life-threatening entity in children, frequently caused by erosive gastritis. Non-steroidal anti-inflammatory drugs are one of the most common class of drugs which can cause gastrointestinal complications, including hemorrhagic gastritis.

Case report: The case of a 6-year-old male, admitted for hematemesis, abdominal pain and loss of appetite. It was ascertained at the time of admission, that ibuprofen had been prescribed as the patient had a fever. This was inappropriately administered as the mother did not respect the intervals between the doses.

Initial laboratory tests revealed neutrophilia, leukopenia, high levels of lactate dehydrogenase and urea. An upper digestive endoscopy revealed an increased friability of the mucosa, digested blood in the gastric corpus and fornix. No active bleeding site was detected. The histopathological examination described a reactive modification of the corporeal gastric mucosa. Intravenous treatment with proton pump inhibitors and fluid replacement were initiated, with favorable results.

Conclusion: Ibuprofen can lead to upper digestive hemorrhage independently of the administered dose. Parents should avoid administering Ibuprofen for fever suppression without consulting their pediatrician.

Open access

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.