Hpv high risk reflex of atypical (age 21)


Având în vedere rata crescută a morbidităţii şi mortalităţii tra­heotomiei la copil, se consideră o intervenţie chirurgicală di­fi­cilă. În lucrare se prezintă managementul şi dificultăţile tehnice ale traheotomiei pediatrice.

Material şi metodă.

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În Clinica ORL Ti­mi­şoa­ra, în perioadaau fost efectuate 18 traheotomii la co­pii cu vârsta cuprinsă între 1 și 15 ani. Indicaţiile traheotomiilor au fost pentru obstrucţie de căi aeriene superioare, ventilaţie asistată sau toaletă pulmonară. Au fost utilizate diferite tipuri de canule tra­he­ale.

Alegerea canulelor trebuie să ţină cont de indicaţia tra­heo­to­miei. Canula ideală trebuie să fie din silicon, uşor de curăţat şi dis­po­nibilă în diferite dimensiuni. Toate traheotomiile au fost efectuate pe incizie cervicală inferioară orizontală. S-a utilizat anes­te­zia generală cu sondă de intubaţie orotraheală, regiunea cer­vi­cală fiind în hiperextensie.

Complicaţiile intraoperatorii au fost minime: uşoa­re hemoragii şi probleme cu canulele traheale. Complicaţiile post­ope­ratorii s-au manifestat ca: decanulare accidentală, emfizem sub­cutanat, dificultăţi de alimentaţie, infecţie.

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Tra­heo­to­mia este considerată o intervenţie cu risc vital, neavând con­traindicaţii absolute. Este o intervenţie dificilă din cauza par­ti­cu­larităţilor papillomaviridae taxonomia la aceste vârste. Traheotomia ar trebui efec­tuată în situaţii controlate cu intubaţie orotraheală pe sondă sau bron­hoscop. Cuvinte-cheie: traheotomie, copil, canulă, complicaţii Eustachian tube causes Adriana Neagoş MD, PhD, University of Medicine and Pharmacy Târgu-Mureş, Otorhinolringology Department, Târgu-Mureş, Romania Eustachian tube is an important source of middle ear pathogenesis and has been linked to causing middle ear and mastoid aeration pathology.

It can appear alone or in association with other factors as sinusitis and epipharingeal tumours. Otitis media with effusion is the most frequent pathology that appears after Eustachian tube disfunction.

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The tympanic membrane retraction is one of objective symptomathology. Many causes of Eustachian tube function and dysfunction are described in the literature including cleft palate, surfactants, tympanic membrane athelectasis, and long term middle ear ventilation. The epidemiological studies illustrated that poor Eustachian tube function plays a major role in the pathogenesis of otits media, so it is very important to have a good function of the tube before and after a surgical procedures.

Evaluation of hearing results demonstrates that preoperative and postoperative tubal function is important for a good surgical outcome in case of chronic otitis media and cholesteatoma. In children the Eustachian tube dysfunction evaluated by impedance audiometer is important to document neutralization of positive and negative middle ear pressures.

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This can be the explanation that Eustachian tube is an essential part of the pressure regulating system of the middle ear. The physiologic function of the tube is to equalize the pressure from the middle ear with the atmosphere. The Eustachian tube closing failure and the induction of negative middle ear pressure are important factors in the development of chronic ear disease.

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Pediatric Resident doctor First described indeafness caused by congenital cyto­me­ga­lo­virus infection - a major problem of public health - is today the most frequent cause of sensorineural deafness in children. The pre­valence of congenital cytomegalovirus infection is between 0. Diagnosis of congenital cytomegalovirus in­fection is cancer pancreatic malign if the virus is isolated during the first 3 weeks of life or if the serum IgM antibodies are found at birth or shortly af­ter birth.

Papilloma kutyaknal caused by cy­to­megalovirus infection can be progressive or with late onset at hpv high risk reflex of atypical (age 21) or in the first years of schoolrequiring more frequent audio­logy monitoring at birth, at 3, 6, 9, 12, 18, 24, 30, and 36 months and annually until school age in order to detect and to treat deaf­ness.

Pathophysiology of deafness caused by cytomegalovirus infec­tion is not completely understood impaired endolymphatic struc­tures, cytopathic effect of the virus, host immune response to the inner ear structures. Hearing loss can be unilateral frequency of kHz or bilateral, and varies from medium to severe.

Hearing im­pair­ment has an impact on social and cognitive development of the child and his family, acquisition of speech being often delayed. The risk of permanent sequelae in case of symptomatic infection is higher in children from mothers suffering of primary infection, but disabilities were observed also in children from mothers with non-primary infections. In children with asymptomatic congenital cy­to­megalovirus infection, increased virulence in the first hpv high risk reflex of atypical (age 21) of life is associated with sensorineural deafness.

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Balance problems invol­ving acoustic nerve should be taken in consideration in children with sensorineural deafness. The relation between high viral charge in infants and deafness probability suggests the role of antiviral the­rapy in decreasing the incidence and the severity of deafness caused by cytomegalovirus.

Oral Valganciclovir represents today an al­ter­native to Ganciclovir, priory used intravenous. Valganciclovir has adverse ef­fects neutropeniathus the decision to initiate the anti­viral therapy is difficult to make. Cochlear implant is efficient in hpv high risk reflex of atypical (age 21) of se­vere deafness in children with congenital cytomegalovirus infec­tion, but the evolution depends on associated psycho-neurological ma­nifestations.

Keywords: infection, cytomegalovirus, deafness, child Difficulties in the diagnosis of hearing loss in children Raluca Enache ENT Sarafoleanu Medical Clinic, Bucharest, Romania Hearing represents an important social and cognitive function, the hear­ing loss being an important health problem worldwide. Hy­po­a­cusis is a common pathology found in both adults and children. Given hpv high risk reflex of atypical (age 21) implications, the diagnosis of hearing loss in children must be done correctly and ra­pidly.

The assessment of the auditory function is indicated in patients with subjective complaints and in those who belong to groups supposed to be at risk for a hearing loss. Paediatric population is part of the se­cond group, children being unable to report deafness occurrence. Keywords: hypoacusis, audiometric evaluation, children Evaluarea beneficiului auditiv la pacienţii cu implant cohlear Mădălina Georgescu1,2, Magda Cernea2,3 1.

Surditatea bilaterală in­sta­lată în primii doi ani de viață determină instalarea unui al doilea han­dicap senzorial - mutitatea, asociere care impietează grav asupra dez­voltării ulterioare a copilului pe multiple planuri: educațional, social și economic.

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Soluția terapeutică adecvată pentru pacienții surzi este re­pre­zentată de implantul cohlear, dispozitiv medical semiimplantabil, care per­mite stimularea directă a nervului auditiv și, în consecință, audiția.

Eva­luarea beneficiului auditiv al implantului cohlear nu trebuie să se li­mi­teze la evaluarea pacienților implantați prin audiogramă tonală, ci, obli­gatoriu, prin audiogramă vocală, singura în măsură să redea nivelul papilloma skin nhs auditive în toată complexitatea sa.

Pe măsură ce copilul surd învață să utilizeze informațiile sonore și să dobândească limbajul articulat, evaluarea standardizată audiologică și logopedică a vorbirii trebuie să fie standardul cuantificării beneficiului implantării cohleare.

Prezentăm în lucrare rezultatele obținute în I. Sunt prezentate elemente de tehnică chirurgicală apli­cate în cazul diferitelor entități patologice, pornind de la vegetațiile ade­noide și ajungând la patologia bazei craniului.

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Se insistă pe pre­zen­tarea modalităților de tratament, pregătire preoperatorie și îngrijiri post­operatorii în cazul patologiei tumorale, cu accent pe prezentarea par­ti­cularităților fibroamelor nazofaringiene. Se­ve­ral substances also can be analysed in saliva and this technique offers some ad­vantages. Saliva sampling hpv high risk reflex of atypical (age 21) be done anytime, anywhere and multiple collection and assessment of samples during the day could offer a better understanding of daily production of the biomarkers of the endocrine and autonomic nervous systems.

Salivary biomarker measures represent a reliable method of investigating hypothalamo-pituitary-adrenal axis and autonomic nervous system activities, avoiding the stressful event of venipuncture and offering the possibility of self-collection by subjects. The aim of this presentation is to encourage the use of salivary biomarkers assays in clinical practice and research and also to provide background information on some methodological factors that influence and hpv high risk reflex of atypical (age 21) variance to bio­marker outcome measurements.

In fact, numerous methodological factors could influence human neuro-endocrine measurements and, consequently, can dramatically hpv high risk reflex of atypical (age 21) the accuracy and validity of research. These factors can be categorized into those that are biologic and those that are procedural-analytic in nature.

hpv high risk reflex of atypical (age 21)

For example, traces of blood might interfere with the results of saliva testing. One major problem, the lack of compliance sometimes seen in outpatient saliva donors, requires strict standardization of both collection and analysis methods to achieve better comparability and assessment of published salivary hormone data. Such effort includes the development of specific and standardized analytical tools, the es­ta­blish­ment of defined reference intervals, and implementation of round-robin trials.

Keywords: salivary biomarkers, hypothalamo-pituitary-adrenal axis, au­to­no­mic nervous system, saliva testing Sleep pathology in children - practical elements Adriana Neagoş MD, PhD, University of Medicne and Pharmacy Târgu-Mureş, Otorhinolaringology Department, Târgu-Mureş, Romania Sleep is important to hpv high risk reflex of atypical (age 21), contributing to their physical and men­­tal growth. There are many possible causes for the development of obstructive sleep apnea in children.

Obstructive sleep apnea syn­drome OSAS in children has different effects, including deficits in cog­­nition and neuropsychological functions, learning problems, hyperactivity, and hpv high risk reflex of atypical (age 21) enuresis. Obstructive sleep apnea in children cha­rac­te­rized by a combination of partial and intermittent obstruction of the upper airway can disturb sleep and normal ventilation. The sym­p­toms are: snoring, difficult breathing during sleep, witness ap­nea and restlessness.

The diagnosis is based on history, physical examination, ENT examination, laboratory, and po­li­somnography.

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All clinical and paraclinical investigations must to be correlated, before establishing the diagnosis, and to evaluate the degree of upper airways obstruction. Hypertrophy of the adenoids and tonsils is a major cause of OSAS in children. These include hyper­trophy of the tonsils and syndromes such as Down syndrome, Pickwickian syndrome, Prader-Willi syndrome or Marfan syndrome.

However, OSAS can also be the result of obesity, midfacial dysplasia, retro- or micrognathia, allergic rhinitis or muscular dystrophy.

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Snoring and obstructive sleep apnea are frequent problems not only in adults, but also in children and adolescents, as can be seen from current epidemiological data. Corrective surgery hpv high risk reflex of atypical (age 21) possible for rare mal­for­ma­tion syndromes. Nocturnal masks for continuous positive airway nasal pres­sure or procedures for mask respiration are effective in children, but are only used in exceptional cases. Dysregulations of the physiological rhythms are thought to play a role in the initiation or progression of some diseases, therefore, we wished to explore HPA axis function in children with obstructive sleep apnea OSA.

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The results showed that the salivary cortisol con­cen­tration measured in the control group reflected a typical course of the salivary cortisol diurnal trajectory, with the evening va­lue being significantly lower than the value in the morning. The mild and moderate OSA groups showed a comparable trend with a sig­ni­fi­cant diurnal decrease in salivary cortisol concentration du­ring the day.

Moreover, we report here that the salivary cortisol con­cen­tra­tion measured in the morning, in both the moderate and mild OSA groups, was significantly higher than that in the control group.

In con­clusion, we showed overall significant and severity-dependent in­creases in salivary cortisol production. In addition, the increased ac­ti­vation of the HPA axis was particularly apparent in the morning and evening, at which time OSA children presented higher levels of cor­tisol than controls. Keywords: hypothalamus-pituitary-adrenal axis, salivary cortisol, obstructive sleep apnea, children Preclinical indicators of autonomic nervous system activity in pediatric osa Lucia Corina Dima-Cozma1, Sebastian Cozma2, Cătălina Elena Lupușoru3, Francesca Romana Patacchioli4, Cristina Mihaela Ghiciuc3 1.

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The aim of the present study was to explore the interdependencies of the two axes and the reliability of salivary alpha-amylase as a noninvasive marker of autonomic nervous sys­tem activation. The results showed a statistically significant dif­fe­ren­ce between the morning and evening salivary alpha-amylase con­cen­­trations in all of the groups, with higher concentrations in the eve­­ning.

The salivary alpha-amylase concentrations measured at no­on in the mild and moderate severe OSA groups were significantly lo­wer than those of the control group. We did not find evidence of au­to­nomic dysregulation concomitant with HPA axis activation. The dif­ferences with other studies from literature could be discussing ta­king in account that our cohort did not include obese children and the duration of the disease was not long enough.

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From a general me­tho­dological viewpoint, the salivary biomarker measurements per­formed in this study represent a reliable and non-invasive source for mo­ni­toring changes in the HPA axis and ANS activities in pediatric sub­jects. The paper aims to study hpv high risk reflex of atypical (age 21) factors influencing diagnostic decision-making in tracheobronchial foreign body suspicion in children, all in order to establish an accurate indication for tracheobronchial exploration. Material and method.

The retrospective study was per­formed on cases with suspected tracheobronchial foreign body TFB in children, hospitalized and treated in the ENT department of the County Clinical Emergency Hospital of Craiova within 5 years. Following history, clinical examination, laboratory findings and tra­heo­bronhoscopy the diagnosis was confirmed in The high percentage of denied cases is due, on one hand, to exploring those hpv high risk reflex of atypical (age 21) where history is suggestive for the diagnosis the presence of the aspiration episodein which case the tracheobronchial exploration is mandatory, and on the other hand, to those cases of pneumonia and bronchopneumonia with prolonged evolution and without positive answer to hpv high risk reflex of atypical (age 21).

Oxiuri la copii de an the age group affected and confirmation of diagnosis for the age group years, there were no errors in diagnosis. Emphysema was the frequent radiological feature found in children.

The percentage of atelectasis increases with the delay of diagnosis, allowing complete blockage of the airways. The high percentage of cases discarded after tracheobronchial exploration is given, on the one hand, to the imperative exploration upon reasonable suspicion of foreign body and, on the other hand, to the confusion ge­ne­rated by pre-existing pulmonary pathology.

Greater prevalence of de­nied cases encountered in the age group years, compared to the other age groups, is probably secondary to a greater degree of freedom gi­ven to the children and less attentive supervision. În ultimii ani s-au fă­cut progrese în caracterizarea variabilităților epidemiologice, fe­no­­tipice, genotipice ale acestor cancere și imu­no­bio­logia a permis un diag­nostic de acuratețe și un prog­nos­tic su­pe­rior prin individualizarea te­ra­peutică.

Specialistul ORL este în eșa­lonul acreditat pentru stabilirea di­ag­nosticului în acest tip de afec­țiune și depistarea în stadiul precoce, fapt ce oferă cele mai im­por­tante premise de supraviețuire. Thrombosis and thrombophlebitis of the lateral venous si­nus LST is one of the complications of otic suppurations in children.

The paper traced the defining diagnostic features and also the actual treat­ment and its controversy. A total of 8 cases, out of which 3 were children, had LST secondary to otic suppurations. All patients un­der­went radical mastoidectomy with exclusion of lateral venous sinus LS on 7 patients.

After mastoidectomy one child was followed-up for over three years by repeated MRI examinations that asserted the re­per­meabilization of the LS. Routine ligation of the internal jugular vein IJV is recommended when the thrombus exceeds the mastoid area, when the IJV is interested or when sepsis and pulmonary complications per­sist.