Inflammatory bowel disease (IBD) is a chronic condition of the gastrointestinal tract comprising of two entities: Crohn disease (CD) and Ulcerative colitis (UC). Considered rare in children in the past, inflammatory bowel disease is nowadays more frequently found, raising diagnostic and treatment challenges.
In our study, we have taken into consideration all children diagnosed with inflammatory bowel disease, in the Department of Pediatrics of the Clinical Emergency County Hospital of Constanta, from 2016 to 2019.
14 children were diagnosed with inflammatory bowel disease during this timeframe, 8 with Crohn disease (57,14%) and 6 with Ulcerative colitis (42,86%). The mean age at onset was 8.2 years for Crohn disease patients, varying between 20 months to 15 years, and 12.8 years for Ulcerative colitis patients, varying between 8 to 14 years.
After a positive diagnosis, different types of induction therapy was implemented, depending on the activity and severity of the disease, as well as on the type of inflammatory bowel disease. 12 patients received iv corticosteroids for an average of five days, followed by oral corticosteroids for 4-8 weeks. Aminosalicylates (Mesalazine) was used as a sole induction treatment in children with UC, or in association with corticosteroids in severe cases (4 cases). Immunomodulatory treatment (Azathioprine) was used for maintaining remission in 5 children with Crohn disease for an average period of 6 months. In 3 cases of CD, antibiotics, such as Metronidazole, were used in the initial treatment.
Biological therapy, such as Adalimumab (ADA), was administered as an induction therapy in patients with refractory to conventional treatment forms, in 5 cases, with a favourable outcome.
Bacterial meningitis is one of the most important medical emergencies, a life-threatening condition that leads to death in all the cases in untreated patients. In infants and young children, especially under 5 years old, the most encountered and severe forms are caused by Streptococcus pneumoniae, Neisseria meningitidis and Hemophilus influenzae type b. The risk of neurological impairment after an acute episode of bacterial meningitis is relatively high. Worldwide, prevention through vaccination decreased dramatically incidence and mortality related to these disease. In Romania vaccination for Neisseria meningitides is optional available for just 6 months, vaccination for Streptococcus pneumoniae by one year, and for Haemophylus influenzae type B is available over 10 years.
We present evolution of a series of three cases with different bacterial meningoencephalitis with severe evolution and prolonged hospitalization. All these cases were reported in unvaccinated children for germs that cause meningitis.
This study aims to characterize the corrosion behavior of steel by static immersion tests in biodiesel obtained from three different types of vegetable oils (sunflower oil, rapeseed oil and corn oil) at room temperature for 49 days. At the end of the test, corrosion behavior was investigated by weight loss measurements and changes in physical and chemical properties of biodiesel. Biodiesel samples were analyzed to investigate density, dynamic viscosity, acidity index, refractive index and saponification index. Results showed that under the experimental conditions, steel was more susceptible to corrosion in biodiesel from corn oil as compared to biodiesel from sunflower oil and rapeseed oil.
Huge amounts of used lubricating oils from automotive sources are disposed of as a harmful waste into the environment. For this reason, means to recover and reuse these wastes need to be found. Problems arising from acid treatment include environmental problems associated with the disposal of acid sludge and spent earth, low product yield (45-65%) and incomplete removal of metals. The processes of re-refining of used lubricating oils depend greatly on the nature of the oil base stock and on the nature and amount of contaminants in the lubricant resulting from operations. The study was carried out on a sample of 15W40 type used oil collected from one automobile. The re-refining process of used oil consists of dehydration, solvent extraction, solvent stripping and vacuum distillation. This study aims to investigate a process of solvent extraction of an alcohol-ketone mixture as a pre-treatment step followed by vacuum distillation at 5 mmHg. The primary step was conducted before the solvent extraction that involves dehydration to remove the water and fuel contaminants from the used oil by vacuum distillation. The solvent extraction and vacuum distillation steps were used to remove higher molecular weight contaminants. The investigated solvent to oil ratios were 2, 3, 4, 5 and 6. The solvent composition is 25% 2-propanol, 50% 1- butanol and 25% butanone or methyl ethyl ketone (MEK). The percentage of oil recovery for the solvent to oil ratio of 6:1 is further improved, but for the ratio values higher than 6:1, operation was considered economically not feasible. Finally, the re-refined oil properties were compared with the commercial virgin lubricating oil properties.
The paper deals with the modal analysis and frequency response analysis of a bucket wheel excavator (BWE) boom, obtained by simulation, based on a virtual model of an existing BWE boom. The boom, which generally is realized as a spatial truss, is the most vulnerable subsystem of the BWE, being submitted to severe operational loads characterized by very pronounced cyclical, dynamic and stochastic variability. This vulnerability is the consequence of its shape and constructive parameters and the nature, source and character of the external exciting loads to which it is exposed. The classical approach recommended by standards and norms cannot predict the occurrence of failures caused by vibration, which produces fatigue due to the load’s cyclical variability and the deformation produced by resonant vibration of some constitutive elements. As exciting load we considered the operational forces acting on the bucket wheel. In this manner we can take into account the constructive features – with modal analysis, and the vibration regime – with frequency response analysis. The proposed method is useful both in the design phase of new load-bearing structures of truss type subjected to high-variability forces, and also in refurbishment or improvement phases of the existing structures of this kind.
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.
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.
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.
BACKGROUND. Ultrasonography has been used in rhinology for diagnosing trauma lesions (fractures, hemosinus), second opinion in tumoral pathology, screening for sinusitis, but on a small scale and with future prospects of cost efficiency.
OBJECTIVE. We hope to grow awareness of the possible use of ultrasound in screening for nasal and paranasal sinuses pathology at the level of ENT emergency departments.
MATERIAL AND METHODS. We describe the technique for ultrasound examination of this region, emphasizing the need for a profound anatomical knowledge characteristic for ENT specialists. Any specialist having access to an ultrasound machine is encouraged to experiment with this imaging procedure. Two cases benefited from the use of ultrasonography in order to receive a better management and a swift treatment. One case presented with a maxillary sinus tumor and another with a paranasal tumor neighbouring the orbit.
CONCLUSION. Ultrasonography of nasal and paranasal sinuses permits serial examination without irradiating the patient; it could be implemented as an addition to FAST-like protocols at the level of emergency departments in order to screen for occult head and neck pathology prior to conventional radiology and CT imaging and thus reducing costs
Introduction. Bisphosphonates (BPs) represent the main therapy in patients with osteoporosis, although a long-term treatment can lead to atypical fractures.
Material and methods. We conducted a retrospective study between 2008 and 2017 and included 23 female patients with atypical femoral fractures (AFFs). The mean period of BPs therapy administration was 5.2 years. We included 7 subtrochanteric fractures and 18 femoral shaft fractures. Two of the total patients presented bilateral femoral fractures. 18 patients presented prodromal symptoms from 2 to 18 months before the diagnosis of fractures, all of them following low energy trauma. All the patients included in our study underwent surgery with intramedullary nail or gamma nail. The postoperative mean follow-up was 2 years. Results. Of all 23 female patients with a total of 25 fractures – 10 underwent osteosynthesis with gamma nail and 15 underwent osteosynthesis with intramedullary nail. From the total number of patients: 13 patients achieved complete union, 6 presented delayed union and 3 non-union (2 intramedullary nail and one gamma nail), whereas in one patient treated previously with gamma nail we observed implant failure.
Conclusion. The treatment of AFFs after BPs therapy administration represents a challenge for orthopaedic surgeons regarding both surgical technique and postoperative follow-up.