Ανατομικές παραλλαγές των κάτω ρινικών κογχών και η κλινική τους σημασία στις επεμβατικές μεθόδους

Ο σκοπός της εργασίας είναι να κατανοήσουμε τη σημαντικότητα της ανατομίας των κάτω ρινικών κογχών και να διακρίνουμε μέσα από τη χρήση διαφορετικών χειρουργικών μεθόδων για την αντιμετώπιση τους, ποια από όλες τις μεθόδους έχει τα καλύτερα δυνατά αποτελέσματα για την αντιμετώπιση αυτών των παραλλαγών. Τα κύρια βήματα είναι ο διαχωρισμός των ανατομικών παραλλαγών και ύστερα μετά από τη χρήση των διαφορετικών χειρουργικών μεθόδων να αποφασίσουμε ποια είναι η καλύτερη αντιμετώπισή τους. Τα αποτελέσματα απορρέουν έπειτα από έναν αξιόλογο αριθμό ασθενών σε κάθε περίπτωση βάση την υποκειμενικότητα του ασθενή αλλά και την μακροσκοπική εικόνα του ιατρού. Η συλλογή του υλικού των ασθενών έγινε στο νοσοκομείο Ευαγγελισμός και ιδιωτικά από το ιατρείο του Δρ. Ω.Ρ.Λ. Νικόλαου Κωνσταντάρα όπου οι ασθενείς χειρουργήθηκαν σε ιδιωτική κλινική. Το διάστημα παρακολούθησης των ασθενών είναι 2 χρόνια και το δείγμα συλλέγετε από 205 περιστατικά.Main purpose of this paper is to fully understand the importance of the anatomy of lower nasal turbinates and through the usage of different treating operative methods, to distinguish which one has the best effective results. The main steps are the separation of anatomical variations and then after using different surgical methods decide which one is the best treatment. The results are derived after an appreciable number of patients in each case based on the subjectivity of the patient but also the macroscopic picture of the doctor. The patients’ collection was from Evangelismos Hospital and from Dr. Nikolaos Konstantaras private practice, where the patients were operated in a private clinic. The patients were monitored for two years and the specimen is from 205 cases

Newborn hearing screening: analysing the effectiveness of early detection of neonatal hearing loss

The introduction of newborn hearing screening programs (NHSP) has drastically contributed to the early diagnosis of hearing loss (HL) in children, with the prospect of children developing speech as early as possible. This retrospective study aims to present and discuss the preliminary results of the NHSP at the University Hospital of Patras, Greece, highlighting the strengths and weaknesses of the program. The evaluation of the implementation of NHSP is important to confirm the effectiveness of the process and elaborate system failures. The study describes the results of previous data collected from the NHSP in the Rio hospital of Patra and analyzed the conditions of the sample collected. The random sample involved newborns born between November 2018 - December 2020 at the University Hospital in Patra, Greece, which was assessed using transient evoked otoacoustic emissions (TEOAEs). Testing was performed twice per week on Thursday and Friday with a random sample, specifically examining the babies in the hospital these days. From the 2014 newborns assessed, 1491 were healthy neonates, while the other 523 required hospitalization in the neonatal unit. In total, there were 2014 live births; 1491 healthy neonates were screened with TEOAEs. Of them, 44 did not pass the first test. After retesting one month later, 31 passed the test, while the other 13 were referred to a hearing center for further audiological testing with auditory brainstem response (ABR) tests. Two infants never showed up for the follow-up appointment. Of the remaining 11, six infants had normal hearing, three had otitis media with effusion or other conductive HL. The last two infants had HL. Specifically, one had bilateral sensorineural HL greater than 40db, and one had unilateral sensorineural HL greater than 40db. Risk factors were identified in 523 newborns admitted to the unit. The most common risk factors identified were the use of ototoxic drugs, low Apgar scores, and prematurity. Of all the newborns, 491 passed the test the first time, and the rest 32 infants came back 1-2 months after leaving the neonatal unit. All the babies who had failed in the first screening test appeared for the follow-up appointment for the second screening test. Of these, 24 babies passed the test, but eight did not. Of these, four were diagnosed with media otitis with effusion or other conductive HL. Sensorineural HL was identified in the last four babies using ABR tests. In detail, two had unilateral sensorineural HL greater than 40db, while two had bilateral sensorineural HL greater than 40db. In conclusion, we found that for the NHS programs to be effective, they must be implemented long-term and have monetary support. Early diagnosis and cochlear implantation are the keys to excellent outcomes. Cooperation between different specialties and a patient-centered approach will help physicians holistically face neonatal HL. Building trust between the parents and doctor is essential for the program's success and reducing the lost-to-follow-up rate. To run a successful program, trained staff, equipment, and financial support are required. However, the gold standards for the success of the program are proper implementation of the program, close follow-up, strict adherence to the guidelines in the neonatal intensive care unit (NICU), and the early detection and diagnosis of HL.Η συγγενής βαρηκοΐα αποτελεί τη συχνότερη συγγενή πάθηση. Τα νεογνά τα οποία έχουν νοσηλευτεί στη μονάδα εντατικής νεογνικής νοσηλείας διατρέχουν μεγαλύτερο κίνδυνο. Η απώλεια ακοής στη νεογνική ηλικία είναι σοβαρή πάθηση διότι αυτή τη περίοδο αναπτύσσεται ο λόγος και αποκτιέται η γλωσσική ικανότητα. Η έγκαιρη διάγνωση και αντιμετώπιση είναι ζωτικής σημασίας. Η μελέτη περιγράφει τα αποτελέσματα από τον έλεγχο της λειτουργικότητας του προγράμματος «καθολικού νεογνικού ελέγχου ακοής» (ΚΝΕΑ) με τη βοήθεια των ωτοακουστικών εκπομπών. Αναλύονται τα δεδομένα που συλλέχθηκαν από το νοσοκομείο του Ρίου της Πάτρας και οι συνθήκες του δείγματος αυτού. Είναι ένα τυχαίο δείγμα που αφορούσε νεογνά που γεννήθηκαν μεταξύ Νοεμβρίου 2018 - Δεκεμβρίου 2020 στο Πανεπιστημιακό Νοσοκομείο της Πάτρας, το οποίο αξιολογήθηκε με χρήση παροδικών προκλητών ωτοακουστικών εκπομπών (ΤΕΟΑΕ). Ο έλεγχος των νεογνών γινόταν δύο φορές την εβδομάδα την Πέμπτη και την Παρασκευή. Τα νεογνά που αξιολογήθηκαν είναι 2014, τα 1491 ήταν υγιή νεογνά, ενώ τα 523 χρειάστηκαν νοσηλεία στη μονάδα εντατικής νοσηλείας νεογνών (ΜΕΝΝ). Συνολικά, μελετήθηκαν 2014 νεογνά. Τα 1491 υγιή νεογνά εξετάστηκαν με ΤΕΟΑΕ. Από αυτά, τα 44 δεν πέρασαν το πρώτο τεστ. Μετά από επανέλεγχο, ένα μήνα αργότερα τα 31 πέρασαν το τεστ, ενώ τα άλλα 13 παραπέμφθηκαν σε κέντρο ακοής για περαιτέρω ακοολογικό έλεγχο με τεστ ακουστικής απόκρισης εγκεφαλικού στελέχους (ABR). Δύο βρέφη δεν εμφανίστηκαν ποτέ στο ραντεβού παρακολούθησης. Από τα υπόλοιπα 11, τα 6 νεογνά είχαν φυσιολογική ακοή, 3 είχαν μέση ωτίτιδα με συλλογή υγρού ή άλλο αγώγιμο απώλεια ακοής. Τα 210τελευταία νεογνά είχαν απώλεια ακόης. Συγκεκριμένα ένα είχε αμφωτερόπλευρη νευροαισθητήρια βαρηκοΐα μεγαλύτερη από 40db και ένα είχε μονόπλευρη νευροαισθητήρια βαρηκοΐα μεγαλύτερη από 40db.Οι παράγοντες κινδύνου εντοπίστηκαν σε 523 νεογνά που εισήχθησαν στη μονάδα νεογνών. Οι πιο συνηθισμένοι παράγοντες κινδύνου που εντοπίστηκαν ήταν η χρήση ωτοτοξικών φαρμάκων, οι χαμηλές βαθμολογίες Apgar score και η προωρότητα. Από όλα τα νεογνά, τα 491 πέρασαν το τεστ την πρώτη φορά και τα υπόλοιπα 32 βρέφη επέστρεψαν μετά από 1-2 μήνες της αποχώρησή τους από τη μονάδα νεογνών. Όλα τα μωρά που είχαν αποτύχει στο πρώτο τεστ προ συμπτωματικού ελέγχου εμφανίστηκαν στο ραντεβού παρακολούθησης για το δεύτερο ακοολογικό τεστ. Από αυτά, 24 μωρά πέρασαν το τεστ των ωτoακουστικών εκπομπων, ενώ τα 8 όχι. Από αυτούς τα 4 διαγνώστηκαν με μέση ωτίτιδα με συλλογή υγρού ή άλλη αγώγιμη απώλεια ακοής.Νευροαισθητήρια απώλεια ακοής αναγνωρίστηκε σε 4 νεογνά χρησιμοποιώντας τεστ ABR. Αναλυτικά, 2 είχαν μονόπλευρη νευροαισθητήρια απώλεια ακοής μεγαλύτερη από 40db, ενώ δύο είχαν αμφοτερόπλευρη νευροαισθητήρια απώλεια ακοής μεγαλύτερη από 40db. Συμπερασματικά, διαπιστώσαμε ότι για να είναι αποτελεσματικά τα προγράμματα του ΚΝΕΑ, πρέπει να εφαρμόζονται μακροπρόθεσμα και να υπάρχει οικονομική υποστήριξη. Η έγκαιρη διάγνωση θα οδηγήσει άλλοτε σε τοποθέτηση ακουστικών βαρηκοΐας και άλλοτε στην κοχλιακή εμφύτευση.Η συνεργασία μεταξύ διαφορετικών ειδικοτήτων(νεογνολόγων, παιδιάτρων, ωτορινολαρυγγολόγων) και η προσέγγιση με επίκεντρο τον ασθενή θα βοηθήσει τους γιατρούς να αντιμετωπίσουν ολιστικά τη νεογνική απώλεια ακοής. Η οικοδόμηση εμπιστοσύνης μεταξύ των γονέων και του ιατρού είναι απαραίτητη για την επιτυχία του προγράμματος, με αποτέλεσμα τη μείωση του ποσοστού απώλειας νεογνών στο στάδιο της παρακολούθησης.Για την εκτέλεση ενός επιτυχημένου προγράμματος, απαιτείται εκπαιδευμένο προσωπικό, σωστός εξοπλισμός και οικονομική υποστήριξη.Τέλος, για την εκτέλεση ενός επιτυχημένου προγράμματος πρέπει να υφίστανται η σωστή εφαρμογή του, η στενή παρακολούθηση των νεογνών και η αυστηρή τήρηση των οδηγιών στη μονάδα εντατικής νοσηλείας νεογνών (NICU)

Atypical Retropharyngeal Abscess of Tuberculosis: Diagnostic Reasoning, Management, and Treatment

Retropharyngeal abscess caused by tuberculosis (TB) is an unusual life-threatening disease. We present the case of a patient, mainly complaining about dysphagia, cephalalgia, and neck pain. History, examination, and laboratory data were inconclusive. Diagnostic imaging revealed retropharyngeal abscess with atypical characteristics. Aspiration through the pharynx was performed. The aspirated fluid sent for microscopic examination by polymerise chain reaction (PCR) gene probe, revealed Mycobacterium tuberculosis (MTB). Subsequently, the patient was treated with a standard nine-month anti-TB chemotherapy. The combination of fine-needle aspiration and antitubercular agents was successful. The aim of the present study is to inform the importance of early diagnosis with targeted therapy

Ameloblastoma on the Maxillary Sinus: Cause of Unilateral Nasal Obstruction

Ameloblastoma is a rare, benign (99%) or malignant (1%) tumour, which has derived from dental mescnchyme. We present a case of a patient mainly complaining about obstruction on the right nasal cavity. Endoscopy and computed tomography revealed a soft tissue mass occupying the maxillary sinus to the middle meatus causing complete obstruction of the right nasal cavity. Endoscopic en block removal of the lesion and biopsy confirmed follicular ameloblastoma. Literature review confirms the extremely rare frequency of ameloblastoma. The aim of the present study is to expand on our knowledge of a rare pathological entity that can frequently be misdiagnosed

Endoscopic Surgical Repair of a Giant, Postoperative, Neglected Meningoencephalocele

Meningoencephalocele is a rare and potentially lethal disease, requiring early diagnosis and treatment. A 30-year-old male patient was diagnosed with a massive meningoencephalocele. His medical history included cerebrospinal fluid (CSF) rhinorrhea since the age of 7 years, which was attributed to right eye mining during infancy due to Coats disease. Following failed attempts of open surgical repair and CSF diversion during childhood, no further attempts of surgical management were made. He presented a long history of recurrent episodes of meningitis, resulting in long-lasting hospitalization in the intensive care unit. Eventually, he underwent surgical repair through an endoscopic multilayer approach. Subsequent endoscopic and radiological assessment demonstrated no recurrence during a follow-up period of one year. Endoscopic treatment is highly successful. An effective and definite surgical repair is of paramount importance in order to avoid life-threatening complications, improve patient's and caregiver's quality of life, and avoid unnecessary health-system costs

Cervical Diffuse Idiopathic Skeletal Hyperostosis: Rare Cause of Emergency Tracheostomy

Diffuse idiopathic skeletal hyperostosis (DISH) is a rare and potentially life-threatening syndrome. We present the case of a patient complaining about severe dyspnoea and diagnosed with vocal cord paresis. An emergency tracheotomy was performed to restore his breathing. Diagnostic imaging revealed large mass-occupying cervical osteophytes compressing the larynx. The osteophytes were removed via an anterior cervical approach, and vital signs were normalized. However, postoperatively, a fistula was discovered between the upper part of the oesophagus and the trachea. As a result, a gastrostomy tube had to be placed indefinitely. Literature review confirms the rare frequency of emergency tracheostomy due to DISH syndrome. The aim of the present study is to expand on our knowledge of a rare pathological entity that can frequently be misdiagnosed

Spinal Accessory Nerve Duplication: A Case Report and Literature Review

Aim of the present study is to expand our knowledge of the anatomy of the 11th cranial nerve and discuss the clinical importance and literature pertaining to accessory nerve duplication. We present one case of duplicated spinal accessory nerve in a patient undergoing neck dissection for oral cavity cancer. The literature review confirms the extremely rare diagnosis of a duplicated accessory nerve. Its clinical implication is of great importance. From this finding, a further extension to our knowledge of the existing anatomy is proposed

Spinal Accessory Nerve Duplication: A Case Report and Literature Review

Aim of the present study is to expand our knowledge of the anatomy of the 11th cranial nerve and discuss the clinical importance and literature pertaining to accessory nerve duplication. We present one case of duplicated spinal accessory nerve in a patient undergoing neck dissection for oral cavity cancer. The literature review confirms the extremely rare diagnosis of a duplicated accessory nerve. Its clinical implication is of great importance. From this finding, a further extension to our knowledge of the existing anatomy is proposed

Newborn Hearing Screening: Analysing the Effectiveness of Early Detection of Neonatal Hearing Loss in a Hospital in Greece

Introduction The introduction of newborn hearing screening programs (NHSP) has drastically contributed to the early diagnosis of hearing loss (HL) in children, with the prospect of children developing speech as early as possible. This retrospective study aims to present and discuss the preliminary results of the NHSP at the University Hospital of Patras, Greece, highlighting the strengths and weaknesses of the program. The evaluation of the implementation of NHSP is important to confirm the effectiveness of the process and elaborate system failures. Materials The study describes the results of previous data collected from the NHSP in the Rio hospital of Patra and analyzed the conditions of the sample collected. The random sample involved newborns horn between November 2018 - December 2020 at the University Hospital in Patra, Greece, which was assessed using transient evoked otoacoustic emissions (TEOAEs). Testing was performed twice per week on Thursday and Friday with a random sample, specifically examining the babies in the hospital these days. From the 2014 newborns assessed, 1491 were healthy neonates, while the other 523 required hospitalization in the neonatal unit. Results In total, there were 2014 live births; 1491 healthy neonates were screened with TEOAEs. Of them, 44 did not pass the first test. After retesting one month later, 31 passed the test, while the other 13 were referred to a hearing centre for further audiological testing with auditory brainstem response (ABR) tests. Two infants never showed up for the follow-up appointment. Of the remaining 11, six infants had normal hearing, three had otitis media with effusion or other conductive HL. The last two infants had HL. Specifically, one had bilateral sensorineural HL greater than 40db, and one had unilateral sensorineural HL greater than 40db. Risk factors were identified in 523 newborns admitted to the unit. The most common risk factors identified were the use of ototoxic drugs, low Apgar scores, and prematurity. Of all the newborns, 491 passed the test the first time, and the rest 32 infants came back 1-2 months after leaving the neonatal unit. All the babies who had failed in the first screening test appeared for the follow-up appointment for the second screening test. Of these, 24 babies passed the test, but eight did not. Of these, four were diagnosed with media otitis with effusion or other conductive HL. Sensorineural HL was identified in the last four babies using ABR tests. In detail, two had unilateral sensorineural HL greater than 40db, while two had bilateral sensorineural HL greater than 40db. Conclusion In conclusion, we found that for the NHS programs to be effective, they must be implemented long-term and have monetary support. Early diagnosis and cochlear implantation are the keys to excellent outcomes. Cooperation between different specialties and a patient-centred approach will help physicians holistically face neonatal HL. Building trust between the parents and doctor is essential for the program's success and reducing the lost-to-follow-up rate. lb run a successful program, trained staff, equipment, and financial support are required. However, the gold standards for the success of the program are proper implementation of the program, close follow-up, strict adherence to the guidelines in the neonatal intensive care unit (NICU), and the early detection and diagnosis of HL