Клинична и диференциално-диагностична характеристика на ангината и нейното място като спешно състояние

Ангината е остро самостоятелно бактериално или вирусно заболяване, което може да се изяви и като симптом на друго инфекциозно или системно заболяване. Под формата си на самостоятелно заболяване се свързва най-често със стрептококова инфекция и е в причинно-следствена връзка с острия ставен ревматизъм. В този обзор ние представяме основните £ клинични и диференциално-диагностични характеристики, както и мястото на това заболяване в спешната помощ.---------------------------------------------------Tonsillitis is an acute bacterial or viral infection of the tonsils that can be primary or a symptom of other infectious or systematic disease. The most common primary tonsillitis is caused by a streptococcus agent and is in a consequent linkage with rheumatism. In this review we scope on the clinical characteristics and differential-diagnosis of the tonsillitis, as also its role as an emergency condition

Epiglottitis

Острият епиглотит (остър супраглотисен ларингит) е стенозиращо гръкляна възпалително заболяване, което изисква адекватни мерки и мероприятия за овладяването му. Боледуват предимно деца на възраст между 1 и 6 години. Острото начало, бързото протичане и прогресивно развиващият се задух изискват транспортирането на детето с линейка на „Бърза помощ“ в специализирано отделение за евентуални интубация или трахеотомия. Без контрол на състоянието на дихателните пътища и медикаментозно лечение симптомите могат бързо да прогресират до дихателна обструкция и смърт в рамките на няколко часа. Най-честият причинител на острия епиглотит е Haemophylus influenza тип B. Изолирани са и други патогенни микроораганизми като стрептококи, стафилококи и пневмококи. Не е изключено да се касае за първична вирусна инфекция с бактериална суперинфекция.------------------------------------------------------Epiglottitis is an acute inflammation in the supraglottic region of the oropharynx. It is a medical emergency in the otorhinolaryngology, which requires adequate measures to manage it. Acute epiglottitis is most common in children aged 1-6 years. The acute onset, rapid course, and progressive dyspnea which are developing children requires transportation by ambulance in a special compartment for possible intubation or tracheotomy. Without airway control and medical management, symptoms may rapidly progress to respiratory obstruction and death in a matter of hours. The most common cause of acute epiglottitis is Haemophylus influenza type B, although some cases are attributable to Streptococcus pneumoniae, Streptococcus agalactiae, Staphylococcus aureus, and Streptococcus pyogenes. It may also be caused by viruses related to upper respiratory infections

Modern Approaches in Injuries of the Larynx

Introduction: Early diagnosis and proper treatment of laryngeal trauma is of great importance for the patient to prevent the formation of stenosis in a later stage, changes in breathing and voice quality.Material and methods: The covered laryngeal trauma is a relatively rare injury. Its incidence is estimated at 1 in 30,000 visits to emergency rooms.Results: Due to their relatively low frequency and association with other life-threatening injuries, laryngeal trauma often go unrecognized. This is bad because the glottis laryngeal stenosis and insufficiency are the end result of delayed or inadequate treatment of laryngeal trauma.Conclusion: Despite the great variety of these injuries, correct diagnosis and understanding of each case justify the adoption of a standardized method for classifying and treating these injuries. These preconditions will facilitate successful therapy

Endoscopic orbital decompression in a patient with a metastasis in the orbit

Endoscopic orbital decompression is an evolving operative technique for managing intraorbital pressure, exophthalmos and reduced visual acuity. We present a clinical case of a palliative orbital decompression in a patient with metastasis in the right orbit from anaplastic carcinoma of unknown origin. Full ethmoidectomy was performed, resection of lamina papyracea and periorbital incisions followed. After surgery patient reported of considerable reduction of pain and exophthalmos but no improvement of visual acuity was registered.Patient carried on his treatment with chemotherapy

Incidence and Significance of Laryngeal Carcinoma

Introduction: Laryngeal carcinoma is the eleventh of the most common malignant neoplasms found in men. Epidemiologically it represents 1.6-2% of all malignant tumors in males and 0.2-0.4% in females.The Aim of the study is to characterize the incidence and significance of laryngeal carcinoma in the population.Materials and methods: Retrospective analysis of patient records. Analysis of the following parameters has been made: age, sex, risk factors, type and frequency of accompanying diseases, ASA. Patients are divided into two groups according to the type of the surgical intervention: 1. Patients undergoing fronto-lateral resection, 2. Patients undergoing total laryngectomy.Results: In both groups most the age of most patients is 51 to 60 years, the male sex is dominant, most of the patients are assessed with ASA III. Systemic alcohol use was reported by 195 patients who underwent fronto-lateral resection and by 520 patients who underwent total laryngectomy. Smoking was reported by 335 patients who underwent fronto-lateral resection and 840 of those who underwent total laryngectomy.Discussion: Based on the demographic analysis, the distribution of patients by sex and age correlates with the results reported by Boring 2 and Muir 3. The predominance of patients in working-age (51-60 years) determines the social significance of the problem. A high percentage of risk factors were found in the study.Conclusion: Laryngeal carcinoma is malignancy with high occurrence and social significance, affecting mostly males in active working-age

Juvenile Nasopharyngeal Angiofibroma – Characteristics, Diagnosis and Treatment

Ювенилният назофарингеален ангиофибром е рядък съдов тумор, срещащ се с честота под 0,5% от всички тумори на главата и шията. Въпреки че е хистологично бенигнен, той притежава локална инвазивност, подобно на злокачествените неоплазми. Лечението до ден-днешен е сериозно предизвикателство, криещо множество рискове от тежки, понякога животозастрашаващи усложнения.Juvenile nasopharyngeal angiofibroma is a rare high vascular tumor with a frequency of less than 0,5% of all head and neck tumors. Although histologicaly benign, it possess invasiveness similar to malignant neoplasms. The treatment is still a challenge with risk of sometimes lifethreatening complications

Infiltrazione macrofagica e densità capillare nel carcinoma della laringe. Studio su 52 casi

L’angiogenesi è uno dei sei principali meccanismi alla base del cancro, ed è stato studiato approfonditamente negli ultimi 20 anni. L’obiettivo del presente studio è stato quello di determinare sia la densità capillare sia l’infiltrato macrofagico nei campioni di carcinoma laringeo e di determinarne la correlazione con gli aspetti clinici e patologici. Sia la densità capillare (CD34) sia l’infiltrato macrofagico (CD68) sono stati determinati con metodiche immunoistochimiche mediante microarray. Il nostro campione ha mostrato una densità capillare media di 14,27 ± 12,92 vasi su campo ingrandito a 200×, e l’infiltrato macrofagico medio è stato di 5,19 ± 4,32. La densità capillare si è dimostrata superiore nei pazienti metastatici. Inoltre uno studio di regressione lineare ha mostrato che l’entità dell’infiltrato macrofagico poteva predire la densità capillare del campione di carcinoma laringeo preso in esame. Non abbiamo invece individuato una correlazione fra ambo i fattori studiati e l’incidenza delle recidive o gli altri fattori clinici presi in esame. Il nostro studio aggiunge dati ad un problema che per quanto studiato a fondo negli ultimi 20 anni resta nella sostanza controverso

Upcoming (potential) obstruction of the Upper Respiratory Tract (URT) from malign origin – problems in the behaviour and in the therapy and treatment

The obstruction of the upper respiratory tract (URT) of adult patients is a medical problem / case, but it becomes a socio-medical one if an obstruction is expected in the future. It represents a serious challenge in the othorhinolaringologic practice mostly with diagnozed, non-treated patients but also with non-diagnosed ill persons. When we consider our practical experience and the results from the modern research, we necessarily enter the area to update the behaviour towards and the treatment of patients with potential ( expected) obstruction

Dyspnoae - diagnosis and treatment under conditions of emergency

Диспнеята представлява качествено променено дишане в резултат на несъответствие между вентилаторните потребности и механичните възможности на торако-пулмоналната система. Несъответствието се изразява в генериране на дихателен стимул, който превишава способността на вентилаторния апарат за адекватен отговор. Задухът бива инспираторен, експираторен и смесен.------------------------------------------------The dyspnoea, is a change in quality of breathing as a result of discrepancies between the ventilator necessities and mechanical capabilities of torako – pulmonary system. Difficult breathing is a result of various pathophysiological mechanisms and have a rich etiology. In terms of urgency it puts a number of tasks of the resuscitation team for hospital care. The next step after getting control of the condition may be proceeding a number of diagnostic procedures, which function is to clarify the pathology and allow consideration of further therapy