INORGANIC FOREIGN BODIES IN THE RESPIRATORY TRACT

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Rhinitis in Early Childhood: Efficiency and Harmlessness of a New Intranasal Corticosteroid

Fluticazone propionate (FP) is a new corticosteroid which is twice as efficient than as beclometazole dipropionate with minimal oral biopresence following intranasal application. Its effect was studied in a total of 400 children aged 4-12 years monitored in 10 of the geographic regions. The efficiency of the drug was assessed by means of daily records registering the individual accompanying symptoms, nasal obstruction, choryza, sneezing, etc. Three groups of patients were investigated: 1) treated with 100 µg FP; 2) treated with 200 µg FP and 3) placebo group. The results of the clinical study confirmed that 100 and 200 µg FP administered once daily suppressed all the typical symptoms of the seasonal allergic rhinits in childhood

ROLE OF THE CYCLIC ADENOSINE MONOPHOSPHATE SYSTEM IN THE EFFECT EXERTED BY SUBSTANCES WITH SELECTIVE INFLUENCE ON MYONEURAL SYNAPSES

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Early detection of subglottic bridge-stenosis following long-term transoral intubation and tracheotomy

Subglottic bridge stenosis (SgBS) after long-term intubation, followed by tracheostomy, which separates the subglottic lumen into an anterior and posterior channels presents a rarity. If not diagnosed it could lead to impairment of the breathing and can be mistaken for bilateral vocal fold paralysis.MATERIAL AND METHODS: A prospective study of the value of transstomal endoscopy with angulated endoscopes to detect subglottic lesions in patients, subjected to tracheostomy after being intubated through the larynx as a routine examination before decannulation. Rigid angulated endoscopes of the Hopkins type with 70o and 90o degrees were used for retrograde transstomal laryngoscopy.RESULTS: Examined were 23 consecutive patients (17 male, 6 female, aged 55,4 ±14 years), which had initially transoral intubation for assisted mechanical ventilation, which later was changed to tracheostomy. In 19/23 (82,6%) of the patients the endoscopic examinations revealed no pathology. In 3/23 (13,4%) transoral laryngoscopy showed immobile vocal folds. The supplementary retrograde transstomal laryngoscopy allowed to differentiate between SgBS (two cases; 8,7%) and vocal fold paralysis (one case; 4,3%). The two cases with SgBS were success fully treated using an endoscopic microlaryngeal technique.CONCLUSION: SgBS are hard to be noticed with standard transoral/transnasal laryngeal endoscopy. The clinical constellation of long-term transoral intubation, followed by tracheostomy seems to be predisposing for the formation of SgBS. The retrograde transstomal laryngocopy is a low resource consuming method, which can be used even in un conscious patients, which do not cooperate for the examination. It allows for optimal examination of the subglottis, the stoma and the trachea before decannulation

AN URGENT TRACHEOTOMIA

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Предимства и недостатъци на транспланти и имплантанти, използвани в уголемяващата ринопластика

Транспланти и импланти в ринохирургията се използват често, за да се реконструира поддържането структури за върха за нос, коригиране на седловиден нос, както и подобряване на функцията на носната клапа или форма на върха на носа. Уголемяващата ринопластика е била прилагана предимно при пациенти от жълтата раса, африканци или афроамериканци. Днес, с бързото развитие на пластичната и естетична хирургия, уголемяващата ринопластика е придобила голяма популярност в Азия. Целта на нашата статия е да представим световния опит по този проблем

Post-tonsillectomy haemorrhage: a retrospective comparison of abscess - and elective tonsillectomy

Objective: There is still controversy as regards the optimal management of peritonsillar abscess. Opponents of tonsillectomy á chaud cite an increased postoperative bleeding risk. Most authors who compared the risks of postoperative haemorrhage after tonsillectomy á chaud and tonsillectomy á froid did not take into consideration criteria such as the age and gender of the patients or the experience of the surgeon. We aimed to eliminate this bias by performing a retrospective study in which a large series of abscess tonsillectomies were compared with an age- and gender-matched group of elective tonsil.Material and methods: All patients had been operated on at the Department of Otorhinolaryngology, St. Marina University Hospital, "Prof. P. Stoyanov"- Varna University of Medicine 1994 and August 2000. There were 350 patients in the abscess tonsillectomy group (61% male, 39% female; mean age 31.8 years; range 3-88 years) and 311 in the elective tonsillectomy comparison group (61% male, 39% female; mean age 30.0 years; range 2-83 years).Results: In the abscess tonsillectomy group, 9 patients (2.6%; confidence level 1.1-4.8%) had postoperative hemorrhages which required treatment under general anesthesia, compared to 17 (5.5%; confidence level 3.2-8.6%) in the age- and gender-matched group of ‘selected` elective tonsillectomies. The difference between these two rates was not significant (p=0.056). The fairly high rate of hemorrhages in the elective tonsillectomy group was mainly due to the effect of the age-matching procedure, which excluded a considerable number of usually unproblematic tonsillectomies for tonsillar hyperplasia in young children. Moreover, our results show that there is a learning curve for surgeons performing tonsillectomies with regard to postoperative hemorrhages.Conclusion: There is no increased risk of postoperative hemorrhage for abscess tonsillectomies in comparison to elective tonsillectomies.Scripta Scientifica Medica 2008; 40(2): 149-15

Septal perforations - are septal buttons better

Objective: To evaluate all cases of septal perforation who underwent closure, either surgically or non surgically, and determine if septal buttons were more effective in terms of successful closure and tolerability to the patients. Study De sign: Ret ro spec tive anal y sis in volv ing 30 pa tients who un der went clo sure of their septal perforation between 1995-2003. Result: 25 patients (84%) had their septal perforations closed by septal button (closed method), 4 underwent surgical closure and 1 patient did not want any treatment. 7 patients, in whom the perforation was closed using septal button, had re-perforation. Conclusion: 90% of the patients had resolution of epistaxis post operatively. Nasal crusting persisted post operatively in 11 patients. 18 patients out of 20 who responded to the questionnaire, had closure by septal button.Scripta Scientifica Medica 2009; 41(2): 147-148

Otitis media and speech and language: a meta-analysis of prospective studies

Considerable controversy surrounds whether a history of otitis media with effusion (OME) in early childhood causes later speech and language problems. We conducted a meta-analysis of prospective studies to determine: 1) whether a history of OME in early childhood is related to receptive language, expressive language, vocabulary, syntax, or speech development in children 1 to 5 years old and 2) whether hearing loss caused by otitis media in early childhood is related to children`s receptive language or expressive language through 2 years of age. We searched on line da ta bases and bib li og ra phies of OME studies and reviews for prospective or randomized clinical trials published between January 2000 and October 2002 that examined there lation ship of OME or OME-associated hearing loss in early childhood to children`s later speech and language development. We performed 11 meta-analyses. There were no significant findings for the analyses of OME during early childhood versus receptive or expressive language during the preschool years in the correlation studies. The magnitude of relationship suggests a small effect, but the 95% CI cannot exclude a trivial (-0.07) or almost good (-0.41) effect. There was a smaller d in the 2 randomized studies (-0.23) than in the observational studies (-0.25), but sensitivity analysis showed no impact of randomization on outcomes (ANOVA: P = .908). Our results indicate no to very small negative associations of OME and associated hearing loss to children`s later speech and language development. These findings may over estimate the impact of OME on outcomes, because most studies did not adjust for known confounding variables