Meningocele in the olfactory area in spontaneous CSF rhinorrhea

Introduction: Spontaneous leakage of cerebrospinal fluid from the nasal cavity due to a defect in the anterior, middle and posterior skull base is a condition associated with both difficult clinical diagnosis and challenges in preoperative localization and treatment.Material and methods: For a period of 19 years in the Clinic of Ear, Nose and Throat at the University Hospital “St. George” were diagnosed 11 cases of spontaneous rhinorrhea with the presence of meningocele in the area of the olfactory cleftResults: In 8 of the clinical cases, we administered intrathecal fluorescein 10% due to the inconclusive data from HRCT and MRI / Cisternography for bone and dural defect in the base area in a positive beta 2 transferrin test. We find that the olfactory cleft is common localization in spontaneous CSF rhinorrhea.Conclusion: The elective choice of diagnostic method with aimed examination for defectarachnoid dilatation in the area of lamina cribrosa, meningocele in the area of the olfactory cleft and those in the sphenoid sinus significantly improves the quality of surgical treatment (preservation of the olfactory area on one side, minimizing orbital and additional dural defects). The discussion in multidisciplinary teams provides significant opportunities for accurate and timely diagnosis of this type of“hidden” defects. ------------------------------------------------------------------------------ Въведение: Спонтанното изтичане на ликвор от носната кухина вследствие на дефект в областта на предна, средна и задна база на черепа е състояние, свързано както със затруднено клинично диагностициране, така и с предизвикателства в предоперативното локализиране и лечение.Материал и методи: За период от 19 години в Клиниката по уши нос и гърло в УМБАЛ „Свети Георги“ са диагностицирани 11 случаи на спонтанна риноликворея с наличие на менингоцеле в областта на олфакторната цепка.Резултати: При 8 от клиничните случаи сме приложили интратекално флуоресцеин 10% поради неубедителните данни от HRCT и МРТ/ цистернография за костен и дурален дефект в областта на базата при позитивен бета 2 трансферинов тест. Установяваме, че олфакторната зона е най-честата локализация при спонтанна риноликворея.Заключение: Елективният избор на метод за диагностика с насочено търсене на дефект-арахноидна дилатация в областта на ламина криброза, менингоцеле в областта на олфактоната цепка, както и такива в сфеноидалния синус значително подобрява качеството в оперативното лечение (запазване на олфакторна зона от едната страна, минимизиране орбитални и допълнителни дурални дефекти). Съвместното дискутиране в мултидисциплинарни екипи дава значителни възможности за акуратната и навременна диагностика на този тип „скрити“ дефекти

A diagnostic approach for identifying defects in the rhinobase

Introduction: Rhinoliquorrhea is a condition characterized by a cerebrospinal fluid leak through the nasal cavity due to a bone ordural defect in the rhinobase. It can be associated with serious lifethreatening conditions such as ascending bacterial infections fromthe non-sterile nasal cavity to the subarachnoid space – meningitis,meningoencephalitis, brain abscess, and others. The diagnostic approach for identifying rhinoliquorrhea is multidisciplinary and depends on the knowledge of different specialists – otolaryngologists, neurosurgeons, general practitioners, radiologists.Materials and methods: For the 2015 – 2019 period 23 patients werediagnosed with rhinoliquorrhea at the Department of Otorhinolaryngology,University Hospital St. George, Plovdiv. They were verified by glucose and Beta-2 transferrin tests. We performed computed tomography, magnetic resonance imaging and cisternography. In cases of a negative CT finding for defects in the rhinobase but clinically positive, we used the method of applying fluorescein intrathecally with intraoperative positivity at the site of the defect.Results: We confirmed pre-operatively that all patients have rhinoliquorrhea, though the localization of the defect in 3 of them differedintraoperatively. In one of the clinical cases, the topical diagnosis ofrhinoliquorrhea was not possible despite the positive result of Beta-2transferrin. Intraoperatively, we detected many small defects in therhinobase area and, in some cases, meningocele in the area of theolfactory rhyme. For most patients the hospital stay lasted for 7 days,while one patient had an intracranial complication – a brain abscess.In all patients we used an endonasal endoscopic approach to surgicallytreat the defects in the rhinobase.Conclusion: The diagnostic approach for identifying defects in therhinobase requires knowledge of the symptom “rhinoliquorrhea”,confirmation of its presence by biochemical tests, and detectionthe osteodural defect by imaging. The diagnostic difficulties arisefrom the diversity in the etiology, the topic and the medical historyof the patient. A long-undetected rhinoliquorrhea may have fatalconsequences for the patient, thus making it a socially significantproblem

Innovative Practices in Educational Technology

Report published in the Proceedings of the National Conference on "Education and Research in the Information Society", Plovdiv, May, 2019To gain a competitive advantage universities have to improve continuously the learning they offer to students and to renew their product offerings. In this paper, we discuss innovations in educational technology and their influence to form a highly connected, interactive and engaging environment within the classroom. We concentrate on the efforts of New Bulgarian University to modernize the learning process and to foster novelties in. We present educational innovations at our university where both the full-time and distance forms of education are enhanced by e-learning.Association for the Development of the Information Society, Institute of Mathematics and Informatics Bulgarian Academy of Sciences, Plovdiv University "Paisii Hilendarski

Visualization and phenotyping of proinflammatory antigen-specific T cells during collagen-induced arthritis in a mouse with a fixed collagen type II-specific transgenic T-cell receptor beta-chain

Introduction: The Vbeta12-transgenic mouse was previously generated to investigate the role of antigen-specific T cells in collagen-induced arthritis (CIA), an animal model for rheumatoid arthritis. This mouse expresses a transgenic collagen type II (CII)-specific T-cell receptor (TCR) beta-chain and consequently displays an increased immunity to CII and increased susceptibility to CIA. However, while the transgenic Vbeta12 chain recombines with endogenous alpha-chains, the frequency and distribution of CII-specific T cells in the Vbeta12-transgenic mouse has not been determined. The aim of the present report was to establish a system enabling identification of CII-specific T cells in the Vbeta12-transgenic mouse in order to determine to what extent the transgenic expression of the CII-specific beta-chain would skew the response towards the immunodominant galactosylated T-cell epitope and to use this system to monitor these cells throughout development of CIA. Methods: We have generated and thoroughly characterized a clonotypic antibody, which recognizes a TCR specific for the galactosylated CII(260-270) peptide in the Vbeta12-transgenic mouse. Hereby, CII-specific T cells could be quantified and followed throughout development of CIA, and their phenotype was determined by combinatorial analysis with the early activation marker CD154 (CD40L) and production of cytokines. Results: The Vbeta12-transgenic mouse expresses several related but distinct T-cell clones specific for the galactosylated CII peptide. The clonotypic antibody could specifically recognize the majority (80%) of these. Clonotypic T cells occurred at low levels in the naïve mouse, but rapidly expanded to around 4% of the CD4+ T cells, whereupon the frequency declined with developing disease. Analysis of the cytokine profile revealed an early Th1-biased response in the draining lymph nodes that would shift to also include Th17 around the onset of arthritis. Data showed that Th1 and Th17 constitute a minority among the CII-specific population, however, indicating that additional subpopulations of antigen-specific T cells regulate the development of CIA. Conclusions: The established system enables the detection and detailed phenotyping of T cells specific for the galactosylated CII peptide and constitutes a powerful tool for analysis of the importance of these cells and their effector functions throughout the different phases of arthritis

A Rare Case Report - Dirofilariasis and B-cell Lymphoma in Cervical Lymph Nodes

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Assessment of postoperative pain and foreign body sensation between two surgical methods coblator-assisted tonsillectomy versus conventional method

The tonsillectomy is one of the most common surgical procedure in the world. One of the commonest complications after the surgery are postoperative bleeding and postoperative pain. In relation with thesecomplains and complications the patients have difficult recovery significantsensation of pain and foreign body sensation. The coblation–assisted tonsillectomy is fairly new surgical method and the focus is in the specific aspects of the surgical techniques and postoperative complications. In our prospective comparative study we include 60 patients divided equally: 30 surgically treated with the coblation method and 30 with conventional method. The average age of the participants is 6,87±3,01 in the first group and 8,16±4,74 in the second group. We compare the postoperative pain and the foreign body sensation in both groups. We measured the postoperative pain using Wong-Baker visual analogue scale with face images (0-no pain; 10-hurts worst). We measured the pain on the 1st – 2nd and 7th day after the surgery. We found statistically significant difference (p-value <0.0005) according to this parameter in both groups. In all of the three days after the surgery the pain is less intensive in the coblation group. Regarding the postoperative pain we found statisticallysignificant differences between both methods in favor of coblatorassistedtonsillectomy (p-value- 0.0002)

Modern approach for complex treatment of odontogenic maxillary sinusitis

Introduction: Odontogenic maxillary sinusitis is associated with diseases of the maxillary teeth. The close anatomical relationship of these teeth with the floor of the maxillary sinus leads to violation of the integrity of its mucosa and creates prerequisites for the infection to pass into the sinus cavity. Odontogenic maxillary sinusitis is characterized by dental complaints and the typical symptoms of all rhinosinusitis. There is lack of consensus in the literature on the algorithm of behaviour in these cases.Aim: To recommend a contemporary algorythm of management in patients with odontogenic maxillary sinuitis, which is consistent with both the established rules for the treatment of rhinosinusitis and the individual characteristics of each clinical case.Materials and methods: For the period 2001-2021, 157 patients were treated at St. George University Hospital, after extraction of an upper tooth (4-6) or with symptoms of nasal breathing difficulties and unilateral whitish secretion with an unpleasant odour. All of them had a history of dental intervention and CT data for changes in the osteomeatal complex or „foreign bodies“ in the maxillary sinus.Results: All patients were discharged on the third day after admission in improved general condition without complaints. No late postoperative complications were observed. In 8 of the patients with sinuscopy, after the control CT examination, performed a month later, a second intervention was necessary for the extraction of residual fungal material.Conclusion: The treatment of odontogenic maxillary sinusitis involves interdisciplinary approach of otorhinolaryngologists and dental specialists. However, modern understanding of the functioning of the nasal cavities and the development of pathological processes in them help us to build and present an adequate concept for diagnosis and therapeutic behavior

Surgical approach for borderline „giant“ osteoma in the frontal sinus. Clinical case. Literature review

Introduction: Osteomas are benign tumors, with slow growth and a long period of asymptomatic development. The paranasal sinuses are often involved, the most affected one being the frontal sinus, followed by the ethmoid, maxillary and sphenoid sinuses. Etiologically, theories of inflammatory, traumatic, genetic genesis should be introduced, but the issue still remains unclear. The diagnosis is very often accidental, when performing radiography or computed tomography (CT). Clinically manifested osteomas with headache, facial deformity, mucocele, intracranial complications are subject to timely surgical intervention. The choice of surgical approach depends on the size of the osteoma and the location, as well as on the professional and technical capabilities given the more specific requirements for the instrument.Materials and methods: We present a clinical case of a 28-year-old man with complaints of headache in the frontal facial area. An X-ray revealed an osteoma in the area of the left frontal sinus, involving more than 2/3 of its cavity. CT was performed and a discussion of the possibilities of endoscopic endonasal surgery, given the borderline „giant“ osteoma with a diagonal size of about 2.75 cm (> 3 cm). An endoscopic endonasal approach was applied.Results: Endoscopic endonasal surgery was performed. The chosen surgical approach was Draf 3 type frontotomy with osteoma extirpation. In early postoperative period– 5 days, there aren’t registreted complications. The patient was followed endoscopically in the second week, first month, sixth month. A month later, a control CT scan was performed with data on residuality on the anterior wall of the frontal sinus, without drainage disturbance. Clinically, the patient has no complaints. There are no late postoperative complications.Conclusion: Symptomatic osteomas of the paranasal sinuses require timely surgery. The choice of surgical approach (open with osteoplastic flap, endonasal or combined) depends on the anatomical location, the size of the tumor, as well as the experience of the surgeon and the technical capabilities of the hospital. Endoscopic endonasal surgery is popular, with highly valued capabilities over time, but in „giant“ osteomas it is debatable given the risk of residuality

Clinical aspects of satellite diseases and cricoarytenoid joint involvement. Arthritis of the cricoarytenoid joint. Clinical case.

Introduction: Laryngeal involvement in rheumatoid arthritis is a rarely mentioned complication in clinical practice. In the literature over the last 10 years, single articles on the subject have been published, presenting a small number of clinical cases. Cricoarytenoid arthritis is a life-threatening condition requiring timely anesthesia and otorhinolaryngological intervention, where the tracheostomy has an important therapeutic place.Aim: With the presentation of our clinical case we aim to expand the knowledge about systemic diseases and their possible acute manifestation in otorhinolaryngological practice. Materials and methods: We present a clinical case of patient M.S., 63 years old, female, with a long medical history of rheumatoid arthritis. She was admitted to the clinic with a tracheostomy cannula placed for acute laryngeal dyspnea. Physical examination with a fibrolaryngoscope revealed bilateral paresis of the vocal folds, in a medial position, without phonatory and respiratory activity. Computer tomography of the neck, chest, with a focus on the mediastinum – without clinical data on tumor processes. Laboratory tests reveal a repeatedly elevated rheumatoid factor.Results: MRI revealed a collapse of the larynx, with pronounced fatty degeneration of the thyroarytenoid and cricoarytenoid muscles. The patient was referred to a rheumatologist to control the chronic exacerbation process, with a definitive tracheostomy cannula.Conclusion: Pathological changes in the cricoarytenoid joint in patients with rheumatoid arthritis, as well as scleroderma, lupus, Felty’s syndrome, Tiez syndrome and other systemic diseases, are a common finding, although diagnosed in the past at autopsy. It can be acute, subacute and chronic, but in otorhinolaryngological practice it occupies an important clinical place in emergencies

Student’s Readiness for E-learning

In this paper, we present our attempt to investigate student’s attitude towards a technology-enhanced learning. We are interested in exploring how learners react to changes in training methodology due to the transition to e-learning. This investigation employs survey research to assess the extent to which students are ready for changes in the training methodology regarding e-forms. Data have been collected over 200 students across different bachelor programs at New Bulgarian University in both full-time and distance forms of studies. The analysis is based on our experience in delivering courses via Moodle for both distance and full-time education. Our results concerning the students’ readiness for e-learning are presented in this paper