BACKGROUND. In case of rhinosinusal malignant tumors, it is important to have a unified and simple terminology. The suprastructure refers to the ethmoid sinus, the sphenoid sinus, the frontal sinus and the olfactory area of the nose. The mesostructure includes the maxillary sinus, excepting the orbital wall, and the respiratory part of the nose.
MATERIAL AND METHODS. We will present two clinical cases admitted and surgically treated in our department. The first one is a left-side suprastructure mass in a 39-year-old male patient, with a particular evolution. The second one is a left-side midfacial and suprastructure tumor with 3 prior negative biopsies in a 57-year-old patient. In both cases, we performed an external surgical approach.
DISCUSSIONS. For an external approach in mesostructure malignant tumors, we propose a combined approach using lateral nasal rhinotomies, sub-labial rhinotomies and midfacial degloving. The external approach in malignant tumors of the supra-structure is centred on a classical incision for the frontal sinus or a hemicoronal or coronal approach. There are some clear advantages of the open approach to be considered.
CONCLUSION. The advantages of the external approach are represented by a direct visualization and control of the tumor during the ablative time; a better control for negative margins; a better control of haemostasis; a better chance for en-bloc resection versus piece-meal resection.
Hemorrhagic Hereditary Telangiectasia (HHT) disease, also called Osler-Weber-Rendu (OWR) disease, is a rare and underdiag-nosed genetic disorder characterized by a multisystemic vascular dysplasia. Nosebleeds, acute or chronic digestive tract bleeding and various problems due to the involvement of major organs (liver, lungs, brain) characterize the disease.
Although it was described at the beginning of the 20th century, many patients, GPs and specialists still ignore the disease, its morbidities and the modalities of the treatment.
That is the reason why the authors have decided to publish this review on this familiar, evolving and potentially life-threatening disease, whose management can be sometimes a real nightmare for the clinician.
OBJECTIVES. Reviewing the literature data related to Lindsay – Hemenway syndrome.
MATERIAL AND METHODS. We searched PubMed and Google Scholar with the key words of “Lindsay-Hemenway syndrome”, “benign positional vertigo”, “vestibular rehabilitation”
RESULTS. Lindsay-Hemenway syndrome is characterized by an association between vestibular neuronitis and BPPV. The specificity of the syndrome consists in the existence of an initial episode of acute vestibular neuropathy manifested by intense vertigo and nystagmus, followed in a variable time frame by episodes of posterior canal BPPV. The treatment of the syndrome consists in a combination of otolith repositioning manoeuvres and vestibular rehabilitation therapy. The physicians involved in treating patients with vestibular disorders should be aware of the existence of this syndrome in order to diagnose and treat the patients accordingly.
CONCLUSION. The Lindsay-Hemenway syndrome is a challenge for the physician. In order to establish a diagnosis, a careful investigation of clinical history and objective examination are needed. The clinician should take into consideration the presence of a sudden vertigo without deafness followed by postural nystagmus, and unilateral labyrinthine hyporeflexia or absence of reflectivity. For a successful therapeutic approach, we should be able to combine manoeuvres of repositioning for BPPV with an appropriate vestibular rehabilitation therapy in order to ensure a correct central compensation of the peripheral unilateral deficit.
The nasal swell body (NSB) is considered to be an enlarged region of the nasal septum, which is located superiorly to the inferior nasal turbinate and anteriorly to the middle nasal turbinate, with a potential effect upon the airflow nasal valve. The histological studies of the NSB demonstrated that it is a glandular formation, not a venous structure, and it is formed by septal cartilage and bone, as well as a thick mucosa. Recent studies emphasized the functional role of the nasal swell body and it is thought to interfere with the nasal airflow and air humidification, due to its proximity to the internal nasal valve and its histological characteristics (venous sinusoids and seromucinous glands). The nasal swell body is strongly related to the presence of rhinosinusal chronic inflammations (allergic rhinitis and chronic rhinosinusitis) and the septal deviation. In case of the presence of the nasal swell body, surgical treatment is not commonly done, due to the absence of a consensus between the ENT practitioners. Most of them consider surgery as being too aggressive because of the presence of seromucinous glands, with slight impact upon the nasal obstruction. Most probably, the lack of consensus is determined by inconsistent anatomical and histological study results.
OBJECTIVE. The purpose of this paper is to describe a simple and safer silicone tube insertion technique in endoscopic dacryocystorhinostomy.
MATERIAL AND METHODS. In our technique, steel wire is inserted into a rigid suction tube (3 mm in diameter) immediately after the medial wall of the sac under endoscopic view. The duration of retrieving the wire from the sac and out of the nasal passage, the number of mucosal lacerations and bleeding were compared with conventional methods such as using retrieval device or forceps.
RESULTS. The duration of retrieving the wire from the sac and out of the nasal passage and mucosal laceration were statistically reduced (P<0.05) in this novel technique when compared with other methods.
CONCLUSION. Sheltering the sharp end of the wire with a suction cannula is a safe and easy method without using any additional tools
Sarcoidosis is a rare condition, presenting with granulomatous lesions typically located in the lungs, spleen and lymph nodes. We present an atypical case of sarcoidosis, with an initial lesion located in the nasopharynx. The patient is a 38-year-old male, with the complaints of cephalalgia, nasal obstruction and hyposmia, detected during further examination with degenerative spinal modifications, prostate inflammation and lung-based sarcoidosis. A biopsy of the lesion located in the postnasal cavity revealed granulomatous origin. The patient underwent total endoscopic adenoid removal and radiofrequency-assisted bilateral turbinate reduction, with favourable post operatory evolution. Atypical localizations of sarcoidosis lesions must be considered in the case of unusual lesions, regardless of localisation.
Intracranial haemorrhage (ICH) is a known, but a rare cause of out of hospital cardiac arrest (OHCA). It results in the development of non-shockable rhythms such as asystole or pulseless electrical activity (PEA).
A 77- years old male had an OHCA without any prodrome. An emergency medical services (EMS) team responded to an emergency call and intubated the patient at the site before transporting him to the Acute Care Hospital, New Brunswick, New Jersey, USA. On admission, a non-contrast computed tomography scan of the head revealed a large cerebellar haemorrhage. Non-traumatic ICH is a rare cause of OHCA. Although subarachnoid haemorrhage causing cardiac arrest has been described in the literature, cerebellar haemorrhage leading to cardiac arrest is rare. The mechanism by which ICH patients develop cardiac arrest is likely explained by a massive catecholamine surge leading to cardiac stunning.
A non-shockable rhythm in the seting of a sudden cardiac arrest should raise alarms for a primary non-cardiac ethology, especially a primary cerebrovascular event. The absence of brainstem reflexes increases the likelihood of an intracranial process.
To evaluate the kinetics of inflammatory biomarkers in septic patients in order to identify the most reliable predictor of unfavorable outcome.
A prospective analysis of septic patients was performed. Median levels of neutrophil/lymphocyte count ratio, fibrinogen, C-reactive protein and procalcitonin were dynamically assessed and comparatively analyzed.
Seventy-seven patients were included. Descendent kinetic patterns were registered for all biomarkers, except C-reactive protein. At 24 hours, neutrophil/lymphocyte count ratio significantly decreased in 42.85% of cases, procalcitonin in 37.33%, C-reactive protein in 16.12% and fibrinogen in 1.58% of cases. At 72 hours, procalcitonin decreased to one-half in 70% of cases and neutrophil/lymphocyte count ratio in 67.53% of cases.
Neutrophil/lymphocyte count ratio and procalcitonin significantly decreased in the first 72 hours, while C-reactive protein increased in the first 24 hours. The proportions of patients with major decrease of baseline values were higher for neutrophil/lymphocyte count ratio and procalcitonin.