Neuroendocrine tumour metastasis to the orbit

Neuroendocrine neoplasms are tumours that usually arise in the gastrointestinal tract and the bronchopulmonary system. The orbit is a rare anatomical site for their metastases. In the following article we present a case report of a 73-year-old man who was admitted to the Ophthalmology Department because of eye pain and high intraocular pressure in the right eye. There was also eye motility restriction, diplopia, oedema of the eyelid, and subconjunctival haemorrhage. Magnetic resonance imaging revealed a tumour in the right orbit, probably arising from the inferior rectus muscle. The patient was qualified for surgery, during which orbit decompression was conducted and a sample of the tumour tissue was collected. Based on the biopsy of the lesion, diagnosis of a metastatic neuroendocrine neoplasm, probably of gastrointestinal origin, was made. Further diagnostic procedures revealed metastases to other organs, and the patient was qualified for oncological treatment. In this case, orbital metastasis was the first diagnosed location of the neoplasm.

“Doctor, my child has something in the nose”

Jedną z częstszych przyczyn niedrożności nosa u dzieci jest ciało obce (c.o.). Objawami c.o. mogą być: jednostronna niedrożność nosa, katar (nierzadko podbarwiony krwią), obrzęk twarzy oraz przykry zapach. Powszechność tych objawów sprawia nierzadko, że rozpoznanie bywa ustalone po pewnym czasie. Autorzy przedstawili materiał Oddziału Otolaryngologii WSZ w Elblągu obejmujące 246 dzieci z c.o. nosa. Materiał podzielono na grupy z uwzględnieniem wieku dziecka. Najczęściej c.o. występowały w grupie dwu- i trzylatków. Najmniej liczną grupę stanowiły dzieci poniżej pierwszego roku życia. Omówiono dokładnie rodzaje c.o. z uwzględnieniem ich budowy, kształtu i lokalizacji. Stwierdzono, że większość ciał obcych miała budowę nieorganiczną, kształt nieregularny i występowała w prawej jamie nosa. U wszystkich dzieci usuwano c.o. przez nozdrze przednie, u 34 (13,8%) ze względu na ich wielkość i lokalizację, zabieg wykonywano w znieczuleniu ogólnym. Szczególną uwagę zwrócono na dokładną ocenę nosa po zabiegu, gdyż długo zalegające c.o. mogą prowadzić do wtórnych zmian degeneracyjnych błony śluzowej (ubytki, owrzodzenia, ziarninowanie i w dalszej konsekwencji zrosty) oraz fakt że u 10 naszych pacjentów (4,1%) mieliśmy do czynienia z jednostronnymi mnogimi c.o. nosa. W omówieniu porównano uzyskane wyniki z danymi z piśmiennictwa oraz szczegółowo przedstawiono sposoby postępowania z c.o. wymagającymi znieczulenia ogólnego.One of the most common causes of nasal obstruction in children is a foreign body (f.b.). Symptoms of the f.b. are: one-sided congestion nose, rhinitis of the nose (often with blood), swelling of the face and odor. The universality of these symptoms often makes the diagnosis is sometimes determined after some time. The authors present the material Department of Otolaryngology Provincial Integrated Hospital in Elbląg, including 246 children with f.b. of the nose. The material was divided into groups based on age. The most frequently f.b. occurred in the group two and three year olds The smallest group were children under one year of age. Authors discussed exactly types f.b. with regard to their structure, shape and location. It was founded that most of the f.b. were inorganic, irregular shape and occurred in the right nasal cavity. In all cases authors removed f.b. by anterior nares, in 34 patients (13.8%) due to their size and location, surgery was performed under general anesthesia. Particular attention was paid to the accurate assessment of the nose after surgery. Long retention f.b. in the nose can lead to secondary degenerative changes in the mucosa (ulcers, granulation and a further consequence adhesions). In 10 of our patients (4.1%) we observed multiple f.b. in one side of the nose. In the discussion authors compares the results with data from the literature and detail the ways to deal with f.b. requiring general anesthesia

Recent achievements in transcatheter closure of ventricular septal defects : a systematic review of literature and a meta-analysis

Background: Ventricular septal defect (VSD) is one of the most common congenital heart defects. Currently, surgery remains the treatment of choice. However, transcatheter techniques for closing of various types of VSDs have become an alternative. Aims: The objective of our study was to present the outcomes of transcatheter closure of various types of VSD based on a systematic review of recent publications. Methods: A systematic review of studies published in English between January 2014 and March 2020 was performed using the PubMed database (MEDLINE) independently by 2 reviewers. Data on success and complication rates were extracted. Studies including fewer than 5 patients and those with acquired VSD were excluded from the analysis. Results: Finally, 44 studies were included for analysis, with a total number of 4050 patients. The pooled estimate of the overall success rate based on the random effects model was 97.96% (95% CI, 97.37–98.56; Q test P 0.99; I 2 = 0%) for permanent VSD. Conclusions: Transcatheter closure of selected VSDs appears to be an effective and safe method of treatment. Recent studies have shown high rates of successful interventions with a low incidence of complications

Optic neuropathy after long-term treatment with tacrolimus — a case series

Introduction. Optic neuropathy is a rare but severe complication of tacrolimus treatment. We present a case series of patients with optic neuropathy after long-term tacrolimus therapy who underwent organ transplantation.Material and methods. The study included 4 patients (8 eyes) who were diagnosed with optic neuropathy in the course of tacrolimus treatment conducted due to a kidney transplant (3 patients) and a liver transplant (1 patient). Each patient underwent an ophthalmic examination (best corrected visual acuity test, applanation tonometry, slit-lamp examination,visual field test) at the time of visual acuity decline and half a year afterward. Additionally, at the second examination, spectral-domain optical coherence tomography (SD-OCT), evaluating the retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer complex (GCL-IPL), was performed.Results. During the first examination, the anterior segment and fundus were unremarkable except for papilledema in the affected eye. Visual acuity, half a year after the onset of neuropathy, was close to the initial state. Intraocular pressure remained stableduring the entire time of follow-up. In the perimetric examination, the neuropathy-affected eye was characterized by concentric narrowing of the visual field during the whole follow-up period. On SD-OCT, in all examined patients, we observed a persistent statistically significant decline in the mean thickness of the RNFL and GCL-IPL. In the case of the RNFL (around the optic disc), injury to superior and inferior sectors prevailed.Conclusion. Tacrolimus-associated optic neuropathy can be observed years after transplantation and with the absence of toxic blood levels. SD-OCT is a quick and non-invasive method of tacrolimus-associated optic neuropathy assessment

Sex- and age-related differences in the management and outcomes of chronic heart failure: an analysis of patients from the ESC HFA EORP Heart Failure Long-Term Registry

Aims: This study aimed to assess age- and sex-related differences in management and 1-year risk for all-cause mortality and hospitalization in chronic heart failure (HF) patients. Methods and results: Of 16 354 patients included in the European Society of Cardiology Heart Failure Long-Term Registry, 9428 chronic HF patients were analysed [median age: 66 years; 28.5% women; mean left ventricular ejection fraction (LVEF) 37%]. Rates of use of guideline-directed medical therapy (GDMT) were high (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers and mineralocorticoid receptor antagonists: 85.7%, 88.7% and 58.8%, respectively). Crude GDMT utilization rates were lower in women than in men (all differences: P\ua0 64 0.001), and GDMT use became lower with ageing in both sexes, at baseline and at 1-year follow-up. Sex was not an independent predictor of GDMT prescription; however, age >75 years was a significant predictor of GDMT underutilization. Rates of all-cause mortality were lower in women than in men (7.1% vs. 8.7%; P\ua0=\ua00.015), as were rates of all-cause hospitalization (21.9% vs. 27.3%; P\ua075 years. Conclusions: There was a decline in GDMT use with advanced age in both sexes. Sex was not an independent predictor of GDMT or adverse outcomes. However, age >75 years independently predicted lower GDMT use and higher all-cause mortality in patients with LVEF 6445%

Principles of qualification and surgical treatment of the nose and paranasal sinuses in the era of COVID-19

Introduction: The COVID-19 pandemic is one of the greatest challenges of modern medicine. Despite implemented social and economic restrictions, the epidemiological situation is still dynamic. Otolaryngologists, especially rhynologists, are at particular risk of SARS-CoV-2 infection. In order to reduce the spread of the virus, it is necessary to implement procedures to minimize the risk of transmission between healthcare professionals and patients. Due to the location of the virus, it is very important with regard to rhinologic procedures and surgery. Literature review: We reviewed the literature on the topic and presented effective methods of reducing the likelihood of virus transmission during surgery of the nasal and paranasal sinuses performed in our center. It is important that the restrictions brought about by the pandemic do not affect the length of diagnostic process and delay initiation of oncological treatment. Malignancies of the nasal region and paranasal sinuses are detected relatively late due to the time the symptoms appear, and further delays starting therapy can be extremely unfavorable. We believe that at present rhinologic procedures, especially in people with unknown epidemiological status, should be limited to the necessary minimum – life-threatening conditions and tumor resections. Even in such cases, however, it is necessary to strictly follow the procedures in order to reduce the risk of virus transmission. We hope that implementation of the guidelines presented in this work will help fight against the current pandemic and its subsequent waves

Małżowina przegrody nosa i jej znaczenie dla rynochirurga

Nasal septal turbinate (NST) is a clearly visible structure located in the anterior part of nasal cavity on the nasal septum that limits the nasal valve laterally. It is often thought that the structure of NST and its function are poorly characterized and are rarely considered by rhinoplasty surgeons during planning and performing surgery. NST represents as a fusiform area of the erectile tissue, similar in structure and function to the nasal turbinate. The central part of NST contains cartilage of the nasal septum, but most of its three-dimensional volume consists of soft tissues: mucosa, erectile tissue, blood vessels and secretory glands. According to various researchers, the main function of NST is to ensure a change in the air flow towards the nasal turbinate and the ostiomeatal complex and humidification of the first portion of the air at the beginning of inspiration. Destruction of NST during septoplasty can lead to tissue drying and predispose to scabs and epistaxis. Preliminary treatment results suggest that NST is an important surgical target in rhinosurgery.Małżowina przegrody nosowej (ang. nasal septal turbinate; NST) to struktura znajdująca się w przedniej części jamy nosowej, która ogranicza przyśrodkowo zastawkę nosową. Struktura NST i jej funkcja są słabo scharakteryzowane i rzadko uwzględniane przez rynochirurgów zarówno w trakcie planowania, jak i wykonywania operacji. NST to wrzecionowaty obszar tkanki z bogatymi naczyniami jamistymi, podobny do małżowin nosowych pod względem budowy i funkcji. Centralna część NST zawiera chrząstkę przegrody nosa, jednak większość jej trójwymiarowej objętości składa się z tkanek miękkich: błony śluzowej, tkanki erekcyjnej, naczyń krwionośnych i gruczołów wydzielniczych. Zdaniem różnych badaczy, główną funkcją NST jest zapewnienie zmiany kierunku przepływu strumienia powietrza w stronę małżowin nosowych i kompleksu ujściowo-przewodowego oraz nawilżanie pierwszej porcji strumienia powietrza wpływającego do nosa w trakcie wdechu. Zniszczenie NST podczas operacji przegrody nosa może doprowadzić do wysuszenia tkanek oraz predysponować do powstania strupów i krwawień z nosa. Wstępne wyniki leczenia sugerują, że NST stanowi ważny cel chirurgiczny w chirurgii nosa i dróg oddechowych