Long-term results of combined approach in parotid sialolithiasis.

Combined sialendoscopic and transcutaneous approach in parotid sialolithiasis is a surgical option for large and impacted stones. The aim of this study is to assess the long-term results regarding postoperative stenosis, recurrent swellings and gland function. Prospective study in a tertiary referral center of patients with parotid sialolithiasis requiring combined approach. A total of 12 patients have been treated within a period of 3 years. Intraductal stents were placed in 9 of 12 cases. Scintigraphic evaluation of salivary glands and follow-up sialendoscopy performed 1 year postoperatively. In total, fourteen stones (two stones in two cases) were successfully removed along with two coexisted inflammatory polyps. Postoperative endoscopic evaluation revealed mild stenosis in 7 out of 12 cases without clinical significance as no recurrent swellings were reported. Scintigraphy showed normal gland function in 11 cases and mild hypofunction in 1 case with long-standing history of sialolithiasis. All patients were free of symptoms within the follow-up period of time (median follow-up 15.5 months). Combined approach is a safe, gland preserving and efficacious procedure in long term. The stenosis in the area of ductal surgical opening when present does not seem to be of clinical value.

A novel technique for mitomycin-c application in frontal sinus surgery.

OBJECTIVE: Local application of mitomycin-c (MMC) seems to be effective in reducing adhesions and stenosis after FESS. However this is not clearly seen in frontal sinusotomy. This study assesses the effectiveness of local MMC in the frontal ostium using a foamy material (otowick) and compared with cottonoids. METHODS: Forty-seven patients with chronic rhinosinusitis without polyps enrolled in this study. Two subgroups were studied: one with MMC application in one nostril using cottonoids and a second with MMC injected in an otowick. In all patients MMC was applied twice, intraoperatively and 4 weeks later. In both groups normal saline was applied to the other nostril on the same material with the MMC side. Six months postoperatively all patients were assessed endoscopically by a clinician blinded to the MMC side. RESULTS: Overall, MMC application was more effective than normal saline in both groups. Otowick use presented favorable initial results especially in primary cases regarding ostium patency, and need for revision surgery. The use of MMC cottonoids did not show any benefit in primary cases. CONCLUSION: The described technique seems to be effective in maintaining frontal ostium patency as it provides a more precise and deeper drug delivery to this area.

Magnetic nanoparticles: An indicator of health risks related to anthropogenic airborne particulate matter.

Due to their small dimensions, airborne particles are able to penetrate through inhalation into many human organs, from the lungs to the cardiovascular system and the brain, which can threaten our health. This work establishes a novel approach of collecting quantitative data regarding the fraction, the composition and the size distribution of combustion-emitted particulate matter through the magnetic characterization and analysis of samples received by common air pollution monitoring. To this end, SQUID magnetometry measurements were carried out for samples from urban and suburban areas in Thessaloniki, the second largest city of Greece, taking into consideration the seasonal and weekly variation of airborne particles levels as determined by occurring traffic and meteorological conditions. The level of estimated magnetically-responding atmospheric particulate matter was at least 0.5 % wt. of the collected samples, mostly being present in the form of ultrafine particles with nuclei sizes of approximately 14 nm and their aggregates. The estimated quantities of magnetic particulate matter show maximum values during autumn months (0.8 % wt.) when increased commuting takes place, appearing higher in the city center by up to 50% than those in suburban areas. In combination with high-resolution transmission electron imaging and elemental analysis, it was found that Fe3O4 and similar ferrites, some of them attached to heavy metals (Co, Cr), are the dominant magnetic contributors arising from anthropogenic high-temperature processes, e.g. due to traffic emissions. Importantly, nasal cytologic samples collected from residents of both central and suburban areas showed same pattern in what concerns magnetic behavior, thus verifying the critical role of nanosized magnetic particles in the assessment of air pollution threats. Despite the inherent statistical limitations of our study, such findings also indicate the potential transmission of infectious pathogens by means of pollution-derived nanoparticles into the respiratory system of the human body.

Evaluation and management of juvenile recurrent parotitis in children from northern Greece.

BACKGROUND: Juvenile Recurrent Parotitis (JRP) is a recurrent parotid inflammation of childhood.  The aim of our study was to investigate the clinical, laboratory and imaging profile of children with JRP as well as to estimate the impact of siadendoscopy as a therapeutic tool in the clinical outcome of JRP. METHODS: Twenty-three children with JRP aged 3.5-16 years, were investigated. Twelve of them underwent sialendoscopy: seven aged <8 years under general and five aged >8 years under local anesthesia. RESULTS: The age at onset ranged from 2-15 years while the number of episodes from 2-8 per year. The autoantibody profile was negative in all patients, suggesting no evidence for autoimmune diseases.  Antibody deficiency was found in two children. The imaging studies reveal an overall parotid swelling and intraparotid lymph nodes while microabscesses were present in 31% of the patients. Twelve patients who underwent sialendoscopy had a significant improvement in their clinical outcome; the mean episodes of JRP before sialendoscopy was 3.9/year and reduced to 0.4 at the post-intervention year. CONCLUSION: Sialendoscopy represents an alternative and promising perspective in the management of JRP. Hippokratia 2015; 19 (4): 356-359.

Cricotracheal separation with multiple cricoid fractures after blunt neck injury: a case report.

BACKGROUND/AIM: Cricotracheal separation is a rare injury with fatal results in most cases. Clear guidelines are not available and several dilemmas are to be faced during patient management in such cases. DESCRIPTION OF CASE: We present a case of cricotracheal separation with multiple cricoid fractures in a 16-year-old male with blunt neck trauma. CONCLUSION: Early recognition based on an index of clinical suspicion is necessary in order to establish this rare diagnosis. Intervention should preserve the laryngeal function as much as possible.

Pediatric sialendoscopy under local anesthesia: limitations and potentials.

OBJECTIVE: Sialendoscopy in children is a recently described procedure. The small amount of existed literature presents the procedure under general anesthesia. We report our experience on pediatric sialendoscopy under local anesthesia at an outpatient setting. METHODS: In a period of 1.5 years 9 children with age >8 years suffering from recurrent parotid swellings were assessed with sialendoscopy. In 8 out of 9 cases the parents accepted a procedure under local anesthesia. In 7 cases the procedure was completed uneventfully however in one case was discontinued and repeated under general anesthesia. The endoscope used was a 1.1mm Marchal type. Prior to endoscopy xylocaine solution 4% was applied on the papilla area for 15min. Intraductal injection of xylocaine 2% (5ml) was performed prior the insertion of the endoscope. During the procedure parents evaluated pain by means of a 6-point smiley scale. Social life and school activity were also evaluated by means of an 11-point scale pre- and 1 year post-sialendoscopy. RESULTS: Seven out of eight children (8 sialendoscopies) tolerated and completed the sialendoscopy assessment. The mean duration of the procedure was 39.2min. No major complications were reported at the early post-endoscopy period. Four children presented no further swellings, two experienced one recurrence and one needed a repeat sialendoscopy (3 recurrent episodes). Sialendoscopy findings showed fibrinous debris in 4 children, mucous plugs in 2, evidence of sialodochitis with purulent debris in one child and stenosis in 3 children. The diagnosis in our cases was Juvenile Recurrent Parotitis in 6 children and chronic microbial parotitis in one case. Social life and school activity were improved in 6 children 1-year post-sialendoscopy according to parent's ratings. CONCLUSIONS: Sialendoscopy under local anesthesia can be an alternative option in children of age >8 years and satisfactory cooperative skills, avoiding unnecessary general anesthesias and hospital stay.

[Volume reduction of tonsil hyperplasia in childhood with a surgical ultrasound device]. / Volumenreduktion bei Tonsillenhyperplasie im Kindesalter durch ein operatives Ultraschallsystem.

BACKGROUND: We present the results of a prospective study concerning the use of a surgical-ultrasound device (use of ultrasound mechanical vibrations in the tonsil tissue with denaturizing effect on collagen and proteins for tonsil ablation, coablation) for the therapy of non-infectious tonsillar hyperplasia resulting in upper airway obstruction in childhood. METHOD: 51 patients with a median age of 6.9 years (3.5-12 years) were treated with surgical ultrasound, under general anesthesia. The intervention did not include tissue excision, but the denaturation of hyperplastic tonsil tissue. Intra- and postoperative bleeding, pain (by visual analog scale), tonsil-to-tonsil diameter and swallowing difficulties were under consideration. Also an bacteriological examination of tonsils was performed. RESULTS: The procedure was generally well tolerated. There was no intra- or postoperative bleeding. Swallowing difficulties were described as not very disturbing. Median follow up was 2.1 years. The postoperative "wound healing" lasted 7-9 days. A reduction of tonsil's size was visible since the first post treatment week with the final results occurring after 3-6 months. Intertonsillar distance was 9 mm preoperatively and 22.14 mm after coablation. A higher incidence of bacterial tonsillitis or development of quinsies were not reported. CONCLUSION: The treatment of tonsilar hyperplasia by means of surgical ultrasound is highly effective and causes relatively mild post surgical complaints without intra- or postoperative bleeding.