Angioedema with life-threatening site is one of the most impressive and serious reasons for presenting to the ENT doctor. Among different causes (tumors, local infections, allergy reactions), an important cause is the side-effect of the angiotensin converting enzyme (ACE) inhibitors drugs. ACE-inhibitors-induced angioedema is described to be the most frequent form of bradykinin-mediated angioedema presented in emergency and also one of the most encountered drug-induced angioedema. The edema can involve one or more areas of the head and neck region, the most affected being the face, the lips, the tongue, followed by the larynx, when it may determine respiratory distress and even death.
There are no specific diagnosis tests available and the positive diagnosis of ACE-inhibitors-induced angioedema is an exclusion diagnosis. The authors performed a review of the most important characteristics of the angioedema caused by ACE-inhibitors and present their experience emphasizing the diagnostic algorithm.
Anca Chiriac, Adrian Naznean, Cristian Podoleanu and Simona Stolnicu
Congenital skin aplasia, known more as aplasia cutis congenita (ACC), is a rare congenital disease, characterized by absence of the skin, observed since birth, more often affecting the scalp and rarely the trunk or limbs. We report here for the first time a non-syndromic localized ACC, characterized by a small solitary area of skin atrophy on the cervical area in a healthy 3-day-old female infant.
Anna-Boróka Tusa, Cristian Podoleanu, Zsuzsanna Szász and Annamária Magdás
Background: Inflammation seems to be the most important trigger for atherosclerosis. Lower extremity artery disease (LEAD) and hypertension (HTN) are the most important atherosclerotic diseases. Total blood count-derived neutrophil-lymphocyte ratio (NLR) and red cell distribution width (RDW) have been proposed as inflammatory biomarkers in cardiovascular diseases. The aim of this study was to assess the correlation with LEAD and HTN.
Material and methods: In total, 134 subjects were included in the study, divided into 2 groups as follows: group 1 – patients with LEAD and HTN; group 2 – subjects with HTN, without LEAD. Complete blood count (CBC) and lipid profile were determined. To assess peripheral artery disease, the ankle-brachial index (ABI) was measured with a handheld Doppler device (BiDop ES100V3 Hadeco®). We compared the inflammatory status between the groups with the use of white blood cell count (WBC), red cell distribution (RDW), and neutrophil-lymphocyte ratio (NLR).
Results: In group 1, there was a significant negative correlation between the ABI and RDW (p = 0.04, r2 = –0.24, 95% CI: 0.4647–0.0013), as well as between the ABI and NLR (p = 0.001, r2 = –0.38, 95% CI: 0.5801–0.1592). In group 2, there was a positive correlation between NLR and total serum cholesterol levels (p = 0.003, 95% CI: 0.1274–0.5472, r2 = 0.12), as well as between NLR and triglyceride levels (p = 0.002, 95% CI: 0.1387–0.5552, r2 = 0.13).
Conclusion: NLR and RDW could represent first-line investigations in patients with cardiovascular disease due their cost efficiency. They can also play a role in triaging patients with atherosclerotic disease, monitoring treatment response and prognosis of the disease.
Ioana Cîrneală, Dan Păsăroiu, István Kovács, Imre Benedek and Rodica Togănel
Kawasaki disease, also known as Kawasaki syndrome or mucocutaneous lymph node syndrome, is a pathology that causes inflammation in the walls of medium sized arteries causing symptoms such as fever, lymphadenopathy, rash, and erythema of eyes, lips, nose, palms and feet. The cause is unknown, although clinical features strongly suggest an infectious etiology. We present the case of a 53-year-old woman, known with Kawasaki disease since childhood, with different associated pathologies, that presented with acute inferior ST elevation myocardial infarction.
BACKGROUND. Sinonasal polyposis represents a chronic inflammatory condition characterized by nasal obstruction, reduction in the sense of smell and impaired quality of life. Intranasal steroids play an important role in preventing the postoperative recurrences in these cases. We carried out a study to evaluate and compare intra nasal budesonide and intranasal fluticasone propionate in the postoperative management of ethmoidal nasal polyposis.
MATERIAL AND METHODS. 106 patients with ethmoidal polyposis were treated with endoscopic polypectomy and were postoperatively started and maintained on intranasal steroids. 54 patients were managed with budesonide and 52 patients maintained on fluticasone propionate nasal spray. The patients were followed-up for 6 months and recurrences and control of symptoms evaluated.
RESULTS. There was a statistical difference in the SNOT-22 (p<0.0001) and Lund-Kennedy scores (p=0.015) between patients using fluticasone propionate as compared to those using budesonide intra nasal spray by the end of the 6th month.
CONCLUSION. Both intranasal budesonide and fluticasone propionate are effective in controlling symptoms after endoscopic sinus surgery in patients with sinonasal polyposis; however, intranasal fluticasone propionate was more efficacious than budesonide in the control of postoperative symptoms.
Vlad Andrei Budu, Tatiana Decuseara, Silviu Crac, Alexandra Gheorghe, Alexandru Panfiloiu and Cristina Goanta
Osteomas are slow-growing tumors of the paranasal sinuses, usually found in the frontal and ethmoidal sinus. In many cases, these tumors are discovered by chance or after an imagistic exam for a non-responsive to medical treatment headache. In asymptomatic tumors, conservative treatment is indicated, while in big tumors with complications the gold standard is surgical resection of the tumor. We present two cases of rather similar anterior ethmoidal osteomas in which the therapeutic management was decided according to the symptomatology of the patient and the imagistic CT exam. We decided different ways of treatment for the two cases based on the CT scan, which has a major role in predicting intraoperative complications during endoscopic sinus surgery.
Andreea Marza, Codrut Sarafoleanu and Gabriela Musat
Inverted or Schneiderian papilloma is a locally aggressive benign tumor with strong recurring tendency and a high potential to transform into a malignant squamous cell carcinoma. Although the clinical characteristics of inverted papilloma, along with the morphological features, have been adequately described, controversy remains with regards to the risk factors and disease etiology. The complete excision of the tumor by surgery is traditionally considered the mainstay of therapy.
This paper updates the state of knowledge and presents our experience from treating 52 patients, diagnosed with inverted papilloma, who underwent surgical treatment in our department. We performed genotyping for Human Papilloma Virus (HPV) for all the patients included in our study group.