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Elena Patrascu and Claudiu Manea

Abstract

Obstructive sleep apnea is a chronic disease characterized by the appearance of apnea or hypopnea episodes during sleep. This condition is associated with several risk factors. Among them, the most important is obesity and it is the only potentially curable. The treatment is polimodal and it involves several therapeutic directions. The purpose of this paper is to establish the role of obesity in the etiology of sleep apnea, as well as the role of the weight loss in its management, both through intensive lifestyle interventions and surgical therapy.

Open access

Krishnamoorthy Madhusudhan, Nor Eyzawiah binti Hassan, Norasnieda binti Md Shukri, Shahrul bin Hitam and Ikmal Hisyam bin Bakrin

Abstract

Small cell neuroendocrine carcinoma (SCNEC) of the nasopharynx and nasal cavity is a rare condition. It is an aggressive malignancy with a high recurrence rate. Despite its rarity in the sinonasal region, it may occur as a second primary malignancy. Patients with cancer of the head and neck region are more prone to develop a second primary tumor due to the field cancerization phenomenon, and a higher incidence is seen in those who have previously received radiation therapy. A detailed clinical and histopathological examination is pivotal to diagnose SCNEC as a second primary malignancy. We wish to highlight such a peculiar case from our center.

Open access

Georgi Petrov Kukushev and Dilyana Vicheva

Abstract

BACKGROUND. The rigid endoscope developed by Karl Storz in 1961 led to a great advance in diagnosis and surgery and nowadays it is the gold standard in routine ENT practice. In addition, the development of video cameras has enhanced the surgical abilities as well as teaching opportunities in endoscopic sinus surgery.

OBJECTIVE. We developed a new prototype endoscope using the “chip-on-the-tip” technology. The aim of our non-clinical study was to observe and discuss the experimental data collected from laboratory tests on plastic models.

MATERIAL AND METHODS. The prototype rigid chip-on-the-tip endoscope has two parts - inner and outer. The inner part includes the chip-on-the-tip camera, light source and the cable. The outer part is a metal tube ending with a 0-degree lens. We performed laboratory tests of the rigid chip-on-the-tip endoscope for rhinosurgery and diagnosis.

RESULTS. We have observed technical parameters of the rigid chip-on-the-tip in order to compare them to conventional endoscopes connected with camera head units that are standard equipment for rhinosurgery and diagnosis.

CONCLUSION. Its advantages compared to the conventional Hopkins endoscope, connected to a standard camera head, are the smaller size, weight and the necessity of only one cable instead of two, allowing easy handling.

Open access

Codrut Sarafoleanu and Raluca Enache

Abstract

Dysphagia is a common disorder associated with a large number of etiologies like aging, stroke, traumatic brain injury, head and neck cancer, neurodegenerative disorders, structural changes or congenital abnormalities. The type of the treatment and its results depend on the type, severity and the cause of dysphagia. The primary goal of dysphagia treatment is to improve the swallowing process and decrease the risk of aspiration.

Along with the existing rehabilitation swallowing treatments, new adjunctive therapy options developed, one of them being the neuromuscular electrical stimulation (NMES).

The authors present the principles of NMES, a small literature review about the results of this therapy and their experience in using transcutaneous NMES in dysphagia patients.

Open access

Daniela Vrinceanu, Ana Maria Oproiu, Mihai Dumitru, Madalina Georgescu and Mariana Costache

Abstract

BACKGROUND. Excision of facial cutaneous carcinomas requires further reconstruction in a combined team with plastic surgeons. Among the traditional risk factors, the unprotected occupational exposure to sunlight can be identified. Giant masses at the level of the nose are frequently squamous carcinomas in origin. Moreover, repeated tumor trauma favours local-regional and remote extension.

MATERIAL AND METHODS. We present step by step the surgical management of an old woman with a nasal mass of 58/36/20 mm. Also, the patient presented right genian tumefaction of approximately 6 months in evolution.

RESULTS. The patient was submitted to surgical resection with free margins, leaving a considerable nasal and genian groove defect. Teaming up with the plastic surgeon, we applied complex reconstruction techniques with a satisfactory aesthetic and functional result. The histopathologic diagnosis confirmed our suspicion of an acantholytic squamous cell carcinoma with lymph nodes metastasis.

CONCLUSION. Our case exhibited traditional risk factors, living in a rural environment. The tumor degree of aggressiveness was increased by repeated self-inflicted trauma. Late presentation to healthcare services implied complex facial reconstruction for the combined resection of the nasal tip and genian lymph node.

Open access

Klaus Vogt, Inese Daine-Loza and Maris Sperga

Abstract

BACKGROUND. Radiofrequency reduction and Coblation are widely used procedures for the treatment of functionally enlarged turbinates with an appropriate outcome. Bleeding and crusting are postoperative complications for Coblation. Thermographic measurements and histological analyses were used to elucidate the causes.

MATERIAL AND METHODS. In a porcine turbinate model, double-needle electrodes of different lengths were tested using a 4MHz radiofrequency current with either automatic energy limitation or a predetermined energy amount of 200 J. Coblation, according to the manufacturer’s instructions, was carried out with a Reflex Ultra 45 wand. The generated temperature was measured with thermo-probes at the tip of the electrodes. The mucosa was subsequently investigated histologically.

RESULTS. Without preoperative saline injection, all procedures generate temperatures < 100° C. After saline injection, excessive temperatures are reached by Coblation after the release of plasma in a closed system. The follow-up is a severe deterioration of the microscopic structures of the mucosa. The low-temperature advantages of Coblation are only effective if the mandatory saline solution rinses the surface. The Radiofrequency applications deliver more predictable results.

CONCLUSION. For the treatment of the functional enlargement of the turbinates, Radiofrequency current with proofed settings should be chosen.

Open access

Andreea Marza and Claudiu Manea

Abstract

We report a case of a 47-year-old patient recently diagnosed with left abducens nerve palsy, who was admitted in our clinic with diplopia. The cranio-facial CT scan revealed left sphenoid fungal rhinosinusitis and the patient underwent endoscopic surgery with complete removal of the fungal material. The immediate postoperative evolution of the patient was favourable, with partial improvement of diplopia. The first month follow-up visit revealed the recurrence of the diplopia, so the patient performed an MRI scan of the brain that showed a cavernous sinus meningioma. The patient was referred to a neurosurgeon who choose a “wait-and-see” strategy instead of surgery.

The paper presents the limits of computed tomography versus magnetic resonance imaging in the radiologic diagnosis of intracranial tumors.

Open access

Sujit Vijay Sakpal, Suresh Kumar Agarwal, Hector Saucedo-Crespo, Christopher Auvenshine, Robert N. Santella, Steven Donahue and Jeffery Steers

Abstract

The critical care involved in solid-organ transplantation (SOT) is complex. Pre-, intra- and post-transplant care can significantly impact both – patients’ ability to undergo SOT and their peri-operative morbidity and mortality. Much of the care necessary for medical optimization of end-stage organ failure (ESOF) patients to qualify and then successfully undergo SOT, and the management of peri-operative and/or long-term complications thereafter occurs in an intensive care unit (ICU) setting. The current literature specific to critical care in abdominal SOT patients was reviewed. This paper provides a contemporary perspective on the potential multifactorial advantages of sub-specialized transplant critical care units in providing efficient, comprehensive, and collaborative multidisciplinary care.

Open access

Manuela Arbune, Silvia Fotea, Aurel Nechita and Victorita Stefanescu

Abstract

Background: Elizabethkingia meningoseptica are Gram-negative rod bacteria which are commonly found in the environment. The bacteria have also been associated with nosocomial infections, having been isolated on contaminated medical equipment, especially in neonatal wards.

Case report: Here, we present the case of a premature female infant born at 33 weeks’ gestational age, with neonatal meningitis. The onset was marked by fever, in the 5th day of life, while in the Neonatal Intensive Care Unit. The patient was commenced on Gentamicin and Ampicillin, but her clinical condition worsened. Psychomotor agitation and food refusal developed in the 10th day of life, and a diagnosis of bacterial meningitis was made based on clinical and cerebrospinal fluid findings. A strain of Elizabethkingia meningoseptica sensitive to Vancomycin, Rifampicin and Clarithromycin was isolated from cerebrospinal fluid. First-line antibiotic therapy with Meropenem and Vancomycin was adjusted by replacing Meronem with Piperacillin/Tazobactam and Rifampicin. The patient’s clinical condition improved, although some isolated febrile episodes were still present. The cerebrospinal fluid was normalized after 6 weeks of antibiotic treatment, although periventriculitis and tetraventricular hydrocephalus were revealed by imaging studies. Neurosurgical drainage was necessary.

Conclusion: Elizabethkingia meningoseptica can cause severe infection, with high risk of mortality and neurological sequelae in neonates. Intensive care and multidisciplinary interventions are crucial for case management.