Surgical approach to giant rhinophyma

Introduction: Giant rhinophyma is a rare condition, representing end-stage rosacea – phymatous rosacea of the nose. This extreme growth of the nasal skin is an embarrassing cosmetic condition.Case report: We present a clinical case of a 76-year old male patient with excessive growth of the nose over years. Apart of the cosmetic condition the patient complained of impaired nasal breathing, which needed stenting of the nostrils and impairment when eating. His facial skin showed typical signs of rosacea. The therapeutic approach chosen included surgical resection with electrocautery and disposable razor blades. The histologic examination of the specimen confirmed the clinical diagnosis. The result achieved was very good both functionally and cosmetically.Conclusion: It is quite debatable why a person with inital rosacea and later progressive rhinophyma seeks no medical advice/treatment or gets no correct medical treatment and follow-up and ends with a debiliating rhinophyma.----------------------------------Въведение: Гигантската ринофима е рядко болестно състояние. Това е краен етап в еволюцията на розацеята – фиматозна розацея на носа. Екстремното разрастване на кожата на носа представлява сериозен естетически деформитет.Клиничен случай: Представяме клиничен случай на 76-годишен пациент с постепенно нарастване на носа в хода на години до ексцесивни размери. Освен самия козметичен дефект, оплакванията на пациента включват затруднено до невъз можност носно дишане, за което той е бил принуден да използва своеобразни стентове и смущения дори на храненето. По лицето му се установяват типични за розацея кожни промени. Терапевтичният подход е хирургически – резекция чрез електроскалпел и послойно изтъняване със самобръсначки. Хистологичното изследване потвърждава клиничната диагноза. Пациентът оценява късния постоперативен резултат като много добър, както във функционално, така и в естетично отношение.Заключение: Открит остава въпросът защо пациент, при който първоначално се развива розацея, която с времето еволюира до ринофима със значителни размери, не търси лекарска помощ или не получава адекватна такава, за да се достигне обезобразяваща гигантска ринофима

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

Morphological studies of the canine hepatic portal system

The aim of the study was to track hepatic veins and their inflow into the caudal hollow vein using corrosion cast, contrast helical computed tomography imaging (CT), conventional ultrasonography (US) and contrast-enhanced ultrasonography (CE-US). The corrosion cast was made on a deceased dog’s liver by injecting solidifying coloured plastic materials through the portal vein and caudal vena cava, enabling macroscopic visualisation of the portal and hepatic venous blood vessel branches up to the perilobular veins. Prior to the CT and US scans, the studied dogs were anaesthetised. The assess-ments were performed following administration of contrast media into the cephalic vein. The CT-scan images, together with the CT and CE-US images of the liver in the transversal and transversal-sagittal planes on the level from the eighth thoracic to the second lumbar vertebras, were compared. The ca-nine hepatic portal system studied using corrosion cast, contrast imaging CT and US methods showed constant pattern of blood supply anatomical disposition. These approaches were used as a model for diagnosing portosystemic shunts in subsequent studies

Sleep and obstructive sleep disordered breathing in early childhood

Sleep is a physiological condition with changes in brain activity, muscle tone and autonomic function (cardiac and respiratory control). Sleep architecture and sleep stages differ and change from fetal life to adulthood. Sleep and breathing are related functions and this relationship is important to the understanding of sleep disordered breathing in children (SDB). Sleep disordered breathing (SDB) encompases a group of disorders characterized by abnormal respiratory patterns or insufficiency of ventilation during sleep. It is a broad spectrum of diseases ranging from snoring to sleep apnea. Investigation of normal sleep in children and violations in breathing during sleep are essential for proper diagnosis and adequate treatment of SDB in pediatric population

Primary sinonasal malignant melanoma – a case report. Do we need postoperative radiotherapy?

Background: Primary sinonasal malignant melanoma represents a rare entity with poor prognosis. In order to increase the diseasefree survival complex treatment approach is recommended (incl. surgery, postoperative radiotherapy (RT) and combined chemotherapy (CCT).Methods: A clinical case of a 64-year old male patient with locally advanced sinonasal malignant amelanotic melanoma with a 2-year follow-up is presented. The optimal treatment strategy is discussed, based on the literature review.Results: In a case of locally advanced sinonasal malignant amelanotic melanoma local tumoral control was achieved by using combined treatment modalities (surgery with mediofacial resection, postoperative RT, several courses of CCT and surgery again). After two years regional disease recurred with involvement of the contralateral neck lymph nodes. There was no evidence of distant spread.Conclusions: The late lymphatic spread of the mucosal melanoma points out the necessity of thorough staging of the neck lymph nodes already at first presentation. In locally advanced mucosal melanoma postoperative RT should be carried out. There is still no uniform opinion on the optimal radiation schedule, the fractionation, the overall dosis and the target volume.--------------------------------------------------------------Увод: Синоназалните малигнени меланоми са редки заболявания с лоша прогноза. За подобряване на свободната от заболяване преживяемост се препоръчва комплексно лечение (хирургия, следоперативна лъчетерапия (ЛТ) и полихимиотерапия (ПХТ)).Материал и метод: Представяме нашите 2-годишни наблюдения при 64‑годишен пациент с локално авансирал синоназален ахроматичен меланом. На фона на литературни данни се обсъжда оптималното комплексно лечение при това рядко срещано заболяване.Резултати: След комбинирано лечение (медиофациална резекция, следоперативна ЛТ; 5 курса ПХТ и реоперация) бе постигнат локален туморен конрол (ЛТК) при локално авансирал меланом на околоносните кухини. Две години след лечението бе диагностициран контралатерален регионален рецидив, без далечно метастазиране.Заключение: Късното лимфно метастазиране при мукозните меланоми, обосновава необходимостта от прецизиране на шийния нодален статус още при диагностициране на заболяването. При локално авансиралите мукозни меланоми се налага провеждане на следоперативна ЛТ, чийто оптимално фракциониране, доза и обем все още не са определени

Urgent pediatric consultation for otologic conditions

Introduction: Pediatric otologic disorders are one of the most frequent reasons for urgent pediatric consultation, thus demanding important medical resources. Objective: The aim of the present study was to give quantitative description of the overall otologic pediatric pathology, presenting to an emergency ENT consultations office in the city of Sofia, Bulgaria. Patients and method: The records of all pediatric patients presented with urgent otorhinolaryngologic symptoms during one calendar year were retrospectively reviewed. Results: Consultations for otologic conditions in children account for 23.7% of all cases and for 55.3% of all pediatric consultations. The leading symptoms were from the external in 14.5% of the cases, form ihe middie ear - in 85.2% and form ihe inner ear in 0.3%. The most frequent etiologies include trauma for the auricle and infections for the external auditory canal and the middle ear. During the different year seasons there is significant variation in the relative incidence of otitis media and otitis externa. Much larger variations show the incidences of different pathologic otologic conditions in the different age groups. Otologic symptoms present an average of 52.8±9.4% of all emergency ENT consultations with an age peak in the age group 3-12 years, reaching up to 66%, followed by a gradual decline. Conclusion: The observed high proportion of children with otologic symptoms seen at an emergency ENT office underlines the importance of this pathology. The data reported could be used as reference when planing the facilities needed to provide adequate specialised medical help in urban areas