598 research outputs found

    Retinoblastoma – a literature review and our experience

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    Retinoblastoma is the most common malignant eye tumor in children that is lethal if left untreated. The contemporary treatment modalities aim not only to save life, but also to preserve the eyes as an organwith form vision and the wich would greatly reflect on the quality of children’s lives. Historically, enucleation was the first successful therapeutic approach to reduce mortality, followed more than 100 years ago by the radiation therapy as the first attempt to save the eyes. Over the last two decades, conservative treatment of retinoblastoma has undergone an impressive development, allowing complete cure with minimal sequelae when timely diagnosed and treated. Today’s treatment protocol includes combination of selective chemotherapy, radiation therapy, laser therapy and, if necessary, systemic chemotherapy. The goal of this article is to review the up-to-date conservative management of retinoblastoma and to emphasize the importance of general practitions and pediatricians for timely diagnosis

    Functional endoscopic sinus surgery (FESS) with navigation system in childhood – our experience. Presentation of clinical cases

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    Introduction: Functional endoscopic sinus surgery (FESS) is the gold minimally invasive standard in diagnosing and surgically treating many diseases of the nose and paranasal cavities. An advantage of FESS is the possibility of application in all age groups.Materials and methods: We observed pediatric patients attended the Otorhinolaryngology Clinic in the University Hospital “Dr. Georgi Stranski” – Pleven in 2021. FESS surgery was performed in the “Integrated interdisciplinary operating unit with navigation and telesurgery systems” at the Center of competence on personalised medicine, 3D and telemedicine, robotic and minimally invasive surgery „Leonardo da Vinci” in Medical University – Pleven.Clinical cases: Case 1: A 7-year-old male patient with orbital complication of rhinosinusitis, with left orbital preseptal cellulitis, without ophthalmoplegia or loss of vision, + ptosis of the eyelid and data on pansinuitis from CT images. Performed FESS found lysis of lamina papyracea with involvement of anterior and posterior ethmoidal cells. Postoperative treatment was done with Ceftriaxone 1g/12h i.v. for 7 days, nasal glucocorticoids and antihistamines.Case 2: A 17-year-old female patient with suggested primary ciliary dyskinesia with a recurrent rhinosinusitis, persistent nasal obstruction, and thick viscous secretions that did not respond to conservative treatment. Sweat test for cystic fibrosis (-). FESS reshaping of the natural openings of the maxillary sinuses and anterior ethmoidectomy were performed bilaterally.Conclusion: FESS is a minimally invasive method, which is suitable for application in pediatric patients. When applied by trained professionals, FESS with an integrated navigation system is optimal for the diagnosis and surgical treatment of chronic and acute rhinosinusitis in children

    Our experience in the surgical treatment of Obstructive Sleep Apnea

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    Background: Obstructive Sleep Apnea (OSA) is a sleep-related breathing disorder, leading to decreased quality of life, increased risk of cardiovascular morbidity and mortality, increased frequency of automobile accidents. Continuous positive airway pressure (CPAP) remains the first line of treatment for OSA. Many patients are unwilling or incapable to tolerate the treatment and therefore turn to surgical options to alleviate symptoms and sequela of the disease.Аim: To present our experience in the surgical treatment of OSA.Materials and Methods: 50 patients (48 male / 2 female) underwent surgical treatment for OSA in our clinic for a period of 10 years. Subjective complaints were evaluated by interview of the patient and partner pre- and postoperatively, with key factors studied being snoring level (visual analogue 1–10) and Epworth Sleepiness Scale (ESS). Objective data were Body Mass Index (BMI), nasal endoscopy, pre and postoperative polysomnographic data, rhinomanometry, Mallampati score, diagnostic imaging of the nose and sinuses.Results: The mean BMI of the patients was 29.8± 3.4. 21 patients had nasal obstruction for which they underwent surgical treatment. 5 patients had micro or retrognathia. 37 Pateints had a Mallampati score of 3 and 13 of 4. All 50 patients underwent Uvulopalatopharyngoplasty (UPPP) and 6 patients also had Radiofrequency tongue base reduction. There were no serious complications. Subjective improvement in the severity of the symptoms was obtained in 88% (44) of patients. Objective success was obtained in 56% (28) of the patients.Conclusions: Surgical treatment of OSA leads to a significant subjective improvement in the severity of symptoms and acceptable objective results. For maximal results a multidisciplinary approach is required for the complex treatment of OSA

    Vitamin D status in children with myopia

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    Introduction. A dramatic increase of myopia worldwide has been observed in recent years. New risk factors for the development of myopia have been the target of numerous investigations. The basis of our research is the correlation between serum levels of vitamin D [25(OH)D] and myopia itself.Purpose: To find out the relationship between serum levels of 25(OH) D and myopia. Patients and methods: The study included 222 children with different refraction status. Full ophthalmologic examination, cycloplegic refraction, echobiometry were performed. The serum levels of 25(OH)D were measured by liquid chromatographic mass spectrometry (level of insufficiency < 80 nmol/L).Results: The average patients’ age (51% boys and 48,2% girls) was 11,7 y (SD ± 3,03). They were subdivided into two groups – children with myopia (84,7%) and those without myopia (15,3%). The mean serum 25(OH)D level of all tested was 61,48 nmol/L (16-140 nmol/L; SD ± 20,15); of myopia – 59,67 nmol/L (16-140 nmol/L; SD ± 19,30) and of the non-myopia group – 71,91 nmol/L (33-111 nmol/L; SD ± 21,79). There was a statistically significant difference in serum levels between the two groups (Đ  = 0,001). The risk of myopia was higher with the decrease of 25(OH)D values (OR = 1,028 ; 95% CI 1,008-1,048). Conclusion. In our investigation group we established low serum levels of 25(OH)D which indicated the need for conducting a population study of its status among Bulgarian children. The correlation between the higher risk of myopia and the vitamin D scarcity has to be further studied, also considering the factor of outdoor/sun-exposure time.

    The application of ultrasound examination in the treatment of Acute Sinusitis. Comparing X-ray to ultrasound of paranasal sinuses

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    Background: Acute rhinosinusitis (ARS) is one of the most common diseases encountered in the out-patient setting. X-ray of the paranasal sinuses is the gold standard in the diagnosis of ARS with its accessibility and accuracy. Ultrasound examination of the paranasal sinuses is a noninvasive diagnostic method which is an acceptable alternative in the follow-up of the treatment.Aim: To present the application of portable sinuson in the out-patient setting on patients with ARS and its effectiveness.Materials and Methods: 22 patients (12m/10f) underwent X-ray of the paranasal sinuses, which resulted in ARS. The results of the X-rays were compared with the ultrasound examination of the paranasal sinuses with a portable sinuson (SINUSULTRA ULTRAMAX). The examination was repeated on the 1-st and 2-nd week and 2 months after the treatment for ARS.Results: From the 22 patients – 10 were with unilateral maxillary sinusitis, 7 with bilateral sinusitis and 5 with pansinusitis. 5 (22%) false positives were registered from the ultrasound examination on the initial check-up, 3 (13%) false negatives were registered on the follow-ups on the 1-st and the 2-nd week, 2 (9%) false negatives were registered 2 months after the treatment for ARS.Conclusion: Ultrasound examination of the paranasal sinuses is a noninvasive, painless, fast and with an adequate degree of accuracy. It is a good alternative for children and pregnant women. Ultrasound examination can be applied in the follow-up of ARS

    Anisotropic inharmonic Higgs oscillator and related (MICZ-)Kepler-like systems

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    We propose the integrable (pseudo)spherical generalization of the four-dimensional anisotropic oscillator with additional nonlinear potential. Performing its Kustaanheimo-Stiefel transformation we then obtain the pseudospherical generalization of the MICZ-Kepler system with linear and cos⁥Ξ\cos\theta potential terms. We also present the generalization of the parabolic coordinates, in which this system admits the separation of variables. Finally, we get the spherical analog of the presented MICZ-Kepler-like system.Comment: 7 page
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