Background
The prevalence of dysphagia in the early phases of multiple sclerosis is 30–40%, with an estimated of 30% of cases going undiagnosed cases. Such complications can lead to malnutrition, ...dehydration, and aspiration pneumonia and have a great impact on the quality of life and psychosocial status of a person with MS. The aim of this study was the validation of dysphagia in multiple sclerosis self-assessment questionnaire (DYMUS) in the Croatian language.
Methods and patients
The cross-cultural adaptation process included a back-forward translation technique of the English language version of DYMUS to the Croatian language, with pilot testing on 30 participants. The validity and reliability of the Croatian version of DYMUS (DYMUS-Hr) was applied to 106 MS patients, with comparison to the Eating Assessment Tool (EAT10), the Water Swallowing Test (WST), and a dichotomous self-assessment question. In the assessment of test-retest reliability, 99 MS patients were included.
Results
Internal consistency of DYMUS-Hr was very good (Cronbach’s alpha—0.837); Cronbach’s alpha was 0.819 for the “dysphagia for solids”, and 0.562 for “dysphagia for liquids” subscale. A significant correlation (
p
< 0.001) was found between DYMUS-Hr and EAT10 (Spearman’s rho—0.787), and WST (Spearman’s rho—0.483). Construct validity was assessed with the self-assessment question and interpreted with the Mann–Whitney
U
test. Test-retest reliability showed moderate to substantial Cohen’s Kappa reliability for each item.
Conclusion
DYMUS-Hr is a valid and reliable screening assessment tool for patients with MS. There is a general lack of awareness about dysphagia symptoms among patients with MS; consequently, this disorder receives inadequate attention and often goes untreated.
Background
Pregnancy-induced rhinitis (PIR) is a form of chronic non-allergic rhinitis not present before pregnancy that manifests itself during pregnancy with complete resolution of symptoms after ...delivery.
Objective
The objective of this ambidirectional longitudinal cohort study is to evaluate the prevalence of PIR and to investigate the appearance and character of its symptoms, and its impact on the quality of life.
Methodology: Six hundred eighty-one (681) women were recruited in the study. They completed questionnaires about nasal symptoms a day after delivery and each woman with nasal symptoms was interviewed 30 days later and data on symptom duration and quality were recorded.
Results
The prevalence of PIR was 31.86% (N = 217), 47.14% (N = 321) women had no nasal symptoms and 21% (N = 143) of participants had prior sinonasal disease. The clinical presentation of pregnancy rhinitis included nasal obstruction as the most common symptom, followed by rhinorrhea, postnasal secretion, nose itching, sneezing, and hyposmia. The median duration of PIR was 4 months with their complete resolution of symptoms between 2th and 16th day after delivery in the majority of respondents. PIR was diagnosed significantly more often if the women carried a female child. PIR affected their quality of life during pregnancy in 53,9% women (N = 117), with an average VAS score of 8. It seems that pregnancy may affect the course of previously present sinonasal disease (allergic rhinitis, chronic rhinosinusitis, nonallergic rhinitis, or non-infectious rhinitis prior to the pregnancy).
Conclusions
PIR is a common clinical entity with a wide range of symptoms with a direct impact on the quality of life in pregnancy. We propose a new definition of pregnancy-induced rhinitis.
Abstract
Sarcomas are a rare heterogeneous group of neoplasms of mesenchymal origin. In the redistribution of all head and neck malignancies, sarcomas are represented by only 1%. Herein, we report a ...case of a 66-year-old patient with right maxillary sinus sarcoma that spread through the ostiomeatal complex, infiltrated the septum, all ethmoid cells, frontal sinus, involved the entire right nasal cavity and penetrated to the nasopharynx. Patient was treated with neoadjuvant chemotherapy, surgery and adjuvant radiotherapy. The histopathology indicated poorly differentiated sarcoma with elements of Ewing’s sarcoma, but also with elements consistent with osteosarcoma. Molecular pathological analysis excluded Ewing's sarcoma. Samples were also sent for review to the other Pathology Clinics. They suggested poorly differentiated high-grade pleomorphic sarcoma with elements of osteosarcoma. The accurate diagnosis of the head and neck sarcoma type can be a histopathology dilemma posing a great challenge in the choice of therapeutic approach, and thus the treatment outcome.
Liposarcoma is a common soft tissue tumor in adults, however, in the head and neck region liposarcomas represent only 2–9% of malignant mesenchymal tumors. The most common are liposarcomas of the ...subcutaneous tissue of the face, scalp, deep soft tissues of the neck, parapharyngeal and retropharyngeal space, and the aerodigestive tract (larynx, oral cavity and pharynx). Liposarcomas of the salivary and thyroid glands have also been described. Liposarcomas generally occur between the ages of 40 and 60, but our patient was only 32 years old when he was diagnosed with liposarcoma in the region 6 of the neck, which is also uncommon and has not been described in the available literature. Liposarcomas are malignant tumors which usually occur de novo. The patient from our case report was diagnosed with lipoma by means of ultrasonography and fine needle aspiration biopsy at the exact location of liposarcoma, and ultrasonographically followed in the period of three years. Because of the acceleration in the tumor growth and signs of volume compression, a possibility of the existence of malignant tumor of fat tissue origin was suspected. Because of the inconvenient tumor localisation and inability of securing wide resection margins, the tumor was resected with margins that were dictated by anatomical relations among the tumor and vital neurovascular structures of the lower neck and mediastinum. As the penetration of the tumor capsule by the tumor tissue was present in the definitive histopathological finding, adjuvant radiotherapy was applied in agreement with the oncologist.
Liposarkomi su učestali tumori mekih tkiva u odraslih, međutim u regiji glave i vrata predstavljaju samo 2–9% malignih mezenhimalnih tumora. Najčešće su to liposarkomi subkutanog tkiva lica, ...vlasišta, dubokih mekih tkiva vrata, parafaringealnog i retrofaringealnog prostora te aerodigestivnog trakta (larinksa, orofarinksa i hipofarinksa). Opisani su i liposarkomi žlijezda slinovnica i štitne žlijezde. Prikazani bolesnik je u trenutku dijagnoze imao samo 32 godine, što je iznimna rijetkost, jer se dob bolesnika sa liposarkomima prema podatcima iz dostupne literature kreće u rasponu od 40 do 60 godina. Lokalizacija tumora u prednjoj regiji vrata suprasternalno također predstavlja rijetko sijelo koje do sada nije opisano u dostupnoj literaturi. Liposarkomi su zloćudni tumori koji najčešće nastaju de novo. U prikazanog pacijenta tumor je smješten u regiji 6 na vratu, citološki dijagnosticiran kao lipom, uz redovite kontrole ultrazvukom praćen u vremenskom intervalu od tri godine. Zbog kliničke slike ubrzanog rasta i početnih znakova volumne kompresije postavljena je sumnja na mogućnost postojanja sarkoma podrijetla masnog tkiva. Zbog nepovoljne lokalizacije i nemogućnosti postizanja širokih resekcijskih rubova, u bolesnika je učinjena potpuna kirurška resekcija tumora s resekcijskim rubovima diktiranim anatomskim smještajem vitalnih struktura vrata i medijastinuma. Kako je u patohistološkom nalazu reseciranog tumora bio opisan proboj čahure, u dogovoru s onkologom provedena je postoperativna adjuvantna radioterapija.
Krikotireotomija ili konikotomija je invazivni kirurški postupak za hitnu uspostavu dišnog puta radi ventilacije i oksigenacije, kada ostale metode nisu moguće, dostupne ili nisu učinkovite. ...Indikacije za zahvat su ozbiljne traume glave i vrata, edem u području lica, ždrijela i gornjeg dišnog puta različite etiologije, laringo-hipofaringealna opstrukcija zbog obostrane paralize glasnica kao posljedica neurološke bolesti, laringealnog tumora, kongenitalne malformacije, intubacije ili masivnog krvarenja ili povraćanja zbog traume glave, kada nije moguća ventilacija ni intubacija. Apsolutnih kontraindikacija za ovaj zahvat nema, dok su relativne malobrojne: laceracija larinksa i traheje s retrakcijom traheje u medijastinum ili bez nje i tad je indicirana traheotomija radi fi ksacije traheje. Krikotireotomija je kontraindicirana kod djece. Za izvođenje zahvata postoji nekoliko tehnika: standardna kirurška tehnika, hitni kirurški postupak i perkutana tehnika. Učestalost komplikacija varira, a među rane (incidencija varira od 0 % do 54 %) možemo ubrojiti krvarenje, laceraciju tireoidne i krikoidne hrskavice ili trahealnih prstena, laceraciju stražnje stijenke traheje i proboj jednjaka, postavljanje kanile u pretrahealni prostor. Moguće kasne komplikacije su subglotična stenoza i poremećaji govora. rikotireotomiju treba prihvatiti kao hitni pristup dišnom putu, a u slučaju daljnje potrebe za prolongiranom ventilacijom (duže od 72 sata) neophodno ju je zamijeniti traheotomijom.
Abstract
Hyalinizing clear cell carcinoma (HCCC) is a rare, predominantly minor salivary gland tumor. Most of these tumors occur in the oral cavity, mainly the palate and tongue. Primary localization ...of the tumor in the region of the nasal cavity and paranasal sinuses is extremely rare and, with only a few cases reported in the literature so far. We present an extremely rare case of a 61-year-old woman with hyalinizing clear cell carcinoma (HCCC), occupying the left posterior nasal and nasopharyngeal cavity, as a primary tumor location. The patient total recovery was uneventful, and she is now free of disease at three years postoperative follow-up.
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