Lyme borreliosis is a vector-borne infectious disease characterized by three disease stages. In the areas endemic for borreliosis, every acute facial palsy indicates serologic testing and implies ...specific approach to the disease. Th e aim of the study was to identify and confirm the value of acoustic refl ex and House-Brackman (HB) grading scale as prognostic indicators of facial palsy in neuroborreliosis. Th e study included 176 patients with acute facial palsy divided into three groups based on serologic testing: borreliosis, Bell's palsy, and facial palsy caused by herpes simplex virus type 1 (HSV-1). Study patients underwent baseline audiometry with tympanometry and acoustic reflex, whereas current state of facial palsy was assessed by the HB scale. Subsequently, the same tests were obtained on three occasions, i.e. in week 3, 6 and 12 of presentation. Th e patients diagnosed with borreliosis, Bell's palsy and HSV-1 differed according to the time to acoustic refl ex recovery, which took longest time in patients with borreliosis. Th ese patients had the highest percentage of suprastapedial lesions at all time points and recovery was achieved later as compared with the other two diagnoses. Th e mean score on the HB scale declined with time, also at a slower rate in borreliosis patients. Th e prognosis of acoustic refl ex and facial palsy recovery according to HB scale was not associated with the length of elapsed time. The results obtained in the present study strongly confirmed the role of acoustic reflex and HB grading scale as prognostic indicators of facial palsy in neuroborreliosis.
Rare Laryngeal Hamartoma: A Case Report Veselski Krajinović, Karolina; Stojadinović, Tomislav; Pajić Matić, Ivana ...
Acta clinica Croatica,
01/2022, Letnik:
61, Številka:
4
Journal Article
Recenzirano
Odprti dostop
Hamartoma (from the Greek language, where
hamartia
means defect or an error and
-oma
denoting a tumor or neoplasm) is a benign tumor-like mass composed of mature tissue or cells that are present in ...abnormal proportions or show a disorganized arrangement. Hamartomas are rarely seen in the head and neck area and especially rare in the larynx. Only few cases of laryngeal hamartoma have been reported in the literature so far. They are usually manifested by stridor, dysphonia and symptoms associated with airway obstruction. The diagnosis must be confirmed histologically and the method of choice in treatment is complete excision of the lesion. The authors present a case of laryngeal hamartoma of a 43-year-old woman treated for hoarseness and paralysis of the left vocal cord.
Rijetke bolesti vestibularnog sustava Butković Soldo, Silva; Tomasović, Sanja; Drviš, Petar ...
Medicina fluminensis,
09/2023, Letnik:
59, Številka:
3
Journal Article
Recenzirano
Vrtoglavica je jedna od najčešćih tegoba na koju se pacijenti žale liječniku. Može se reći da poremećaj ravnoteže tijekom života doživi oko trećina cjelokupne ljudske populacije pa otuda njegov ...veliki javnozdravstveni značaj. Ne radi se o jednoj bolesti, već se u slučaju vrtoglavice radi o sindromu koji uključuje stotine različitih uzroka. Liječniku kliničaru to može na prvi pogled djelovati zastrašujuće, ali nakon dublje analize shvaćamo da ogromnu većinu vrtoglavica čini deset najčešćih uzroka, dok se svi ostali mogu svrstati u rijetke bolesti prema važećoj definiciji koja kaže da se svaka bolest koja zahvaća < 5 : 10 000 ljudi smatra rijetkom. Ovo nas upućuje na zaključak da ovakve bolesti nikako ne bi trebalo zanemariti u procesu diferencijalno-dijagnostičkog promišljanja. Može se reći da su rijetke bolesti rijetke, ali da su oboljeli od njih vrlo brojni. Otprilike 5000 - 8000 različitih rijetkih bolesti pogađa 6-8 % stanovništva Europske unije, odnosno između 27 i 36 milijuna ljudi. U ovom tekstu pozornost smo posvetili onim rijetkim vestibularnim poremećajima koji su važni za svakodnevno dijagnostičko, posebice diferencijalno-dijagnostičko promišljanje. Neki od ovih poremećaja, iako po našem mišljenju imaju veliku diferencijalno-dijagnostičku važnost, još uvijek nisu uvršteni na listu rijetkih entiteta ORPHA, dok su s druge strane uvršteni dobro nam poznati i etablirani poremećaji ili pak oni potpuno beznačajni za svakodnevnu liječničku praksu zbog svoje enormno niske učestalosti.
Dizziness is one of the most common symptoms that patients complain about to their doctors. It can be said that around one third of the entire human population experiences dizziness during their lifetime, and hence its great public health significance. It is not a single disease, however: in the case of dizziness, it is rather a syndrome, which involves hundreds of different causes. It may seem scary to a clinician, but we might realize subsequent to an in-depth analysis that ten dizziness causes are most common, while the remaining ones might be classified as rare diseases, according to the current definition. Consequently, they should not be ignored in a differential-diagnostic process. Actually, any disease that affects < 5:10.000 people is considered rare. It can be said that rare diseases are infrequent, but the patients suffering from them are numerous. Five to eight thousand different rare diseases affect 6-8% of the European Union (EU) population--that is, between 27 and 36 million people. In this article, we have paid attention to those rare vestibular disorders that are significant for quotidian diagnostics, especially with regard to a differential-diagnostic excogitation method. In spite of their major differential-diagnostic importance, some of these disorders are still not included in the ORPHA list of rare entities. On the other hand, the well-known and established disorders, or those that are completely insignificant for everyday medical practice, are enlisted due to their enormously low frequency.
Hamartoma (from the Greek language, where hamartia means defect or an error and -oma denoting a tumor or neoplasm) is a benign tumor-like mass composed of mature tissue or cells that are present in ...abnormal proportions or show a disorganized arrangement. Hamartomas are rarely seen in the head and neck area and especially rare in the larynx. Only few cases of laryngeal hamartoma have been reported in the literature so far. They are usually manifested by stridor, dysphonia and symptoms associated with airway obstruction. The diagnosis must be confirmed histologically and the method of choice in treatment is complete excision of the lesion. The authors present a case of laryngeal hamartoma of a 43-year-old woman treated for hoarseness and paralysis of the left vocal cord. Key words: Hamartoma; Larynx; Vocal cord paralysis Hamartom (iz grckog hamartia, ?to znaci gre?ka, defekt i -oma, oznacava tumor ili neoplazmu) je benigna masa izgledom slicna tumoru, sastavljena od zrelih tkiva ili stanica koje pokazuju poremecaj proporcija ili se pojavljuju u neorganiziranom rasporedu. Hamartomi rijetko zahvacaju podrucje glave i vrata, a jo? rjede ih pronalazimo u podrucju larinksa. Dosad je u literaturi opisano samo nekoliko slucajeva laringealnih hamartoma. Najce?ce se manifestiraju stridorom, disfonijom te simptomima vezanim uz opstrukciju di?nih putova. Dijagnoza se postavlja patohistolo?ki, a metoda izbora u lijecenju je potpuna ekscizija lezije. Autori prikazuju slucaj laringealnog hamartoma u 43-godi?nje ?ene obradivane zbog promuklosti i pareze lijeve glasnice. Kljucne rijeci: Hamartom; Larinks; Pareza glasnice
Uvod: Vrtoglavica je iluzija rotacije prostora koja se javlja zbog oštećenja vestibularnog sustava. S obzirom na mjesto oštećenja razlikujemo periferne i centralne vrtoglavice. Među najčešće ...periferne vrtoglavice ubrajamo benigni paroksizmalni pozicijski vertigo (BPPV) i vestibularni neuronitis. Hipofunkcija labirinta uslijed vestibularnog neuronitisa nastaje zbog senzorineuralnog oštećenja, dok je BPPV uzrokovan mehaničkim promjenama u polukružnim kanalićima, tj. migriranjem kristala kalcijevog karbonata. Osim spomenute razlike, vestibularni neuronitis i BPPV razlikuju se po duljini trajanja simptoma i vrsti nistagmusa koji stvaraju. Dijagnozu oba poremećaja postavljamo kliničkim pregledom, uz pomoć dobro definiranih testova, a laboratorijska ispitivanja ravnoteže mogu nam poslužiti kao koristan alat u potvrdi dijagnoze, lokalizaciji oštećenja i praćenju oporavka. Iako su oba poremećaja česta, simultana pojava BPPV-a bočnog kanala i vestibularnog neuronitisa rijedak je entitet, te pretraživanjem literature pronalazimo dva opisana slučaja. Prikaz slučaja: Ovaj rad opisuje 49-godišnju bolesnicu s vrtoglavicom kojoj smo dijagnosticirali benigni paroksizmalni pozicijski vertigo bočnog kanala i istostranu perifernu vestibulopatiju. Bolesnica je dobro reagirala na repozicijski postupak i vestibularnu rehabilitaciju, što je dovelo do oporavka vestibularne funkcije kroz nekoliko mjeseci. Zaključak: Položavajuće probe potrebno je raditi kod svih bolesnika s vrtoglavicom, a u slučaju dijagnoze BPPV-a bočnog kanalića, pseudonistagmus se ne smije zamijeniti spontanim nistagmusom. Laboratorijski testovi vestibularne funkcije indicirani su kod nejasnih slučajeva.
Vestibularna rehabilitacija jest planirani, individualno prilagođen sustav vježbi kojima se ubrzava proces središnje kompenzacije oštećenoga vestibularnog sustava. U medicinu ju uvode Cawthorne i ...Cooksey sredinom prošloga stoljeća. Godinama su postojali prijepori o značenju i učinkovitosti ovoga načina liječenja. Provedene su brojne randomizirane prospektivne kliničke studije, koje su dokazale važnost vestibularnih vježbi, kao i njihov povoljan učinak na brzinu i stupanj oporavka bolesnika, tako da one posljednjih desetljeća zauzimaju sve značajnije mjesto u liječenju vrtoglavica. Vestibularna hipofunkcija, bilo da je riječ o akutnome ili kroničnom poremećaju, ili pak o jednostranome ili obostranom oštećenju, predstavlja dosta čest problem za liječnika praktičara, osobito onoga koji se bavi problemima vrtoglavica. Premda je vestibularna rehabilitacija za većinu poremećaja ravnoteže metoda izbora u liječenju, ona je kod nas još uvijek podosta zapostavljena i neopravdano podcijenjena. Cilj ovih Smjernica za kliničku praksu jest pomoći liječnicima i fizioterapeutima pri ujednačavanju pristupa pacijentima s jednostranim i obostranim vestibularnim oštećenjima, izbjegavajući nepotrebne varijacije u primjeni vestibularnih vježbi. One nisu udžbenik niti jedini i neupitni izvor znanja, već pružaju okvir za strategiju kod donošenja odluka, ne zamjenjujući pritom značenje kliničke prosudbe. Vestibularnim vježbama značajno se ubrzava oporavak bolesnika s vestibularnom hipofunkcijom i njihov povratak uobičajenim životnim aktivnostima. Svrha ovih Smjernica jest utvrditi koga, kada, kako i koliko dugo liječiti, kao i kako otkloniti nepotrebne varijacije u pristupu rehabilitaciji pacijenata s vestibularnom hipofunkcijom. One se zasnivaju na dokazima dobivenim metaanalizom podataka iz dostupne medicinske literature, oslanjajući se pored toga i na naše dugogodišnje iskustvo u radu s vertiginoznim pacijentima.
Summary
The aim of this study was the determination of bacteria present in maxillary and ethmoid cavities in patients with chronic sinusitis and to correlate these findings with bacteria ...simultaneously present in their nasopharynx. The purpose of this correlation was to establish the role of bacteria found in chronically inflamed sinuses and to evaluate if the bacteria present colonized or infected sinus mucosa. Nasopharyngeal and sinus swabs of 65 patients that underwent functional endoscopic sinus surgery were cultivated and at the same time the presence of leukocytes were determined in each swab. The most frequently found bacteria in nasopharynx were
Staphylococcus aureus
,
Staphylococcus epidermidis
,
Streptococcus
spp.,
Streptococcus viridans
and
Streptococcus pneumoniae
. Maxillary or ethmoidal sinus swabs yielded bacterial growth in 47 (72.31%) patients. The most frequently found bacteria in sinuses were
Staphylococcus epidermidis
,
Staphylococcus aureus
,
Klebsiella
spp. and
Streptococci
(
pneumoniae
,
viridans
and spp.). The insignificant number of leukocytes was present in each sinus and nasopharyngeal swab. Every published microbiology study of chronic sinusitis proved that sinus mucosa were colonized with bacteria and not infected, yet antibiotic therapy was discussed making no difference between infection and colonization. Chronic sinusitis should be considered a chronic inflammatory condition rather than bacterial infection, so routine antibiotic therapy should be avoided. Empiric antibiotic therapy should be prescribed only in cases when the acute exacerbation of chronic sinusitis occurs and the antibiotics prescribed should aim the usual bacteria causing acute sinusitis. In case of therapy failure, antibiotics should be changed having in mind that under certain circumstances any bacteria colonizing sinus mucosa can cause acute exacerbation of chronic sinusitis.
Differences in acute external injuries of the larynx and cervical trachea between peace-time and war trauma were studied. Twenty-six patients with peace-time injuries and 39 patients with war ...injuries were retrospectively analyzed. The incidence of peace-time laryngotracheal injuries was 0.91% of the total number of patients hospitalized for head and neck injuries. In the groups of wounded in action (WIA) and killed in action (KIA) with head and neck war injuries, the incidence of laryngotracheal injuries was 4.8 and 6.2%, respectively. According to the type of the wound, blunt injuries were most common among peace-time and penetrating wounds among war injuries. There was no difference between peace-time and war injuries according to the wound localization. War wounds were more severe, caused more extensive local tissue and organ defects, were associated with a greater number of lesions to the neck and other body regions and more often required reconstructive surgical procedures than peace-time injuries. The mortality of war laryngotracheal injuries was two times greater than that of peace-time lesions (9 vs. 3.8%).
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