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.
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Material şi metodă. 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.
Mult mai mult decât documente.
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. Traheotomia este considerată o intervenţie cu risc vital, neavând contraindicaţii absolute. Este o intervenţie dificilă din cauza particularităţilor anatomice 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.
Laryngeal papillomatosis ct 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. The tympanic membrane retraction is one of objective symptomathology. Many causes of Eustachian tube function and dysfunction are described laryngeal papillomatosis ct 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 laryngeal papillomatosis ct after a surgical procedures.
Evaluation of hearing results demonstrates that laryngeal papillomatosis ct 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. This can stromae p 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. Pediatric Laryngeal papillomatosis ct 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 possible if the virus is isolated during the first 3 weeks of life or if the serum Laryngeal papillomatosis ct antibodies are found at birth or shortly after birth. Deafness caused by cytomegalovirus infection can be progressive or with late onset at preschoolers 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.
LARYNGEAL PAPILLOMATOSIS, Causes, Signs and Symptoms, Diagnosis and Treatment
In children with asymptomatic congenital cytomegalovirus infection, increased virulence in the first month of life is associated with sensorineural deafness. Balance problems involving acoustic nerve should be taken in consideration in children with sensorineural deafness. The laryngeal papillomatosis ct 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 laryngeal papillomatosis ct antiviral therapy is difficult to make.
Cochlear implant is efficient in case 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 these 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.
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А зачем это нам? - спросила Сьюзан.
Даже через несколько часов после смерти лицо азиата отливало чуть розоватым загаром.
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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. Soluția terapeutică adecvată pentru pacienții surzi este reprezentată de implantul cohlear, dispozitiv medical semiimplantabil, care laryngeal papillomatosis ct 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 abilitării 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.
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 can 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 add variance to biomarker outcome measurements. In fact, numerous methodological factors could influence human neuro-endocrine measurements and, consequently, laryngeal papillomatosis ct dramatically compromise the accuracy and validity of research.
These factors can be categorized into those that are biologic and those that are procedural-analytic in nature. 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 laryngeal papillomatosis ct in children - practical elements Adriana Neagoş MD, PhD, University of Medicne and Pharmacy Târgu-Mureş, Otorhinolaringology Department, Târgu-Mureş, Romania Sleep is important to children, 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 nocturnal enuresis.
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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. 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. 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 is 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 laryngeal papillomatosis ct some diseases, therefore, we wished to explore HPA axis function in children with obstructive sleep apnea OSA.
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 laryngeal papillomatosis ct 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 laryngeal papillomatosis ct 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.
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 papillomavirus humains informations lower than those of the control group. We did laryngeal papillomatosis ct find evidence of autonomic laryngeal papillomatosis ct 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 laryngeal papillomatosis ct the duration of the disease was not long enough.
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 the factors laryngeal papillomatosis ct 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 laryngeal papillomatosis ct, clinical examination, laboratory findings and traheobronhoscopy the diagnosis was laryngeal papillomatosis ct in The high percentage of denied cases is due, on one hand, to exploring those cases 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 treatment.
Analyzing 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 laryngeal papillomatosis ct 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 laryngeal papillomatosis ct 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.