Ischemic Stroke in the Course of COVID-19 in a 16-Year-Old Boy.

The SARS-CoV-2 virus that causes COVID-19 disease is still evolving and, despite the end of the acute phase of the pandemic, still poses a risk to public health. One of the very rare complications, occurring in less than 1% of children, is multisystem inflammatory syndrome in children (MISC). Due to the risk of thromboembolic complications as well as cardiac problems, MISC carries a number of life-threatening complications. We report a case of a 16-year-old boy who was hospitalized due to general weakness, fever, conjunctivitis, vomiting and diarrhoea. In view of the mother's positive result of the SARS-CoV-2 test, the teenager underwent numerous laboratory tests. Taking into account the critical condition of the patient, anticoagulant and antipyretic treatment, steroids and IVIG were added. During hospitalisation, alarming symptoms occurred, including dysarthria, drooping corner of the mouth and muscle weakness on the right side. The magnetic resonance imaging showed changes characteristic of ischemic stroke. Further studies are needed to assess possible thrombotic complications in children after SARS-CoV-2 infection, and specialists should be more vigilant in paediatric patients presenting with such symptoms.

Gonadotropin-Releasing Hormone Antagonists-A New Hope in Endometriosis Treatment?

Endometriosis is a chronic disease, in which endometrial-like tissue is found outside the uterine cavity. Lesions are typically located in the true pelvis but can be found, in addition to extragenital endometriosis, in the respiratory system, the diaphragm, the pleura or the pericardium. As the extrauterine endometrial lesions undergo the menstrual cycle, they cause many symptoms, including pain, and besides infertility, they all mostly affect the quality of the patient's life. Pharmacological management of endometriosis significantly increases in importance either as a first-line treatment or as a complementary therapy after surgery. Yet, current research on antagonists of the gonadotropin-releasing hormone (GnRH) has revealed their potential benefits in endometriosis treatment. Their mechanism of action is to down-regulate the hypothalamic-pituitary-gonadal axis and therefore induce a hypoestrogenic state. The resulting reduction of estrogen levels prevents disease progression and diminishes the recurrence rate after surgical removal of endometriosis. The present review summarizes recent reports of the role oral GnRH antagonists have as a significant treatment option for pain reduction in endometriosis patients.

Rehabilitation in the treatment of mandibular condyle fractures.

BACKGROUND: The objective of rehabilitation after the treatment of a mandibular condyle fracture is to retrieve the effortless, symmetrical opening of the jaws with the preservation of appropriate movements to the sides, and appropriate occlusion without a sense of tension in the mastication muscles or pain sensations. OBJECTIVES: The aim of the article was to establish the conditions of the rehabilitation of temporomandibular joint (TMJ) after the surgical treatment of a fractured condyle. MATERIAL AND METHODS: The research featured 46 of patients treated surgically between January 2, 2017 and December 30, 2017. The open reduction and rigid internal fixation (ORIF) was the method mainly applied. Rehabilitation with the use of the Delphi technique was implemented in each patient. The assessment of the mastication organ was mostly performed at 3 and 6 weeks since the beginning of rehabilitation. In every patient, the interincisal distance was measured; in chosen cases, the range and trajectory of the condyle movements, and the trajectory of the secant point during jaw opening were defined with the use of the Zebris® JMA device. RESULTS: In 45 patients, a full reposition and immobilization of 52 bone fragments of fractured mandibular condyles was obtained. The displacement of the midline of the mandible in occlusion or an incorrect occlusion contact determined the decision on the application of intermaxillary fixation in 8 patients for a period of 2 weeks. The minimal jaw opening of 40 mm was achieved in 41 patients after 6 weeks of rehabilitation. In 5 of the rest of the patients, rehabilitation had to be continued. The reassessment of the X-ray images and additional computed tomography (CT) diagnosis in three-dimensional (3D) reconstruction in those patients revealed the possible causes of difficulties in the restoration of the stomatognathic system functions ­ the injuries of the muscles or ligaments connected with the joint. CONCLUSIONS: The extension of radiological diagnostics with a CT examination may improve the assessment of the restored TMJ function after the surgical treatment of a fractured mandibular condyle.

Laparoscopic enhanced-view totally extraperitoneal Rives-Stoppa repair (eTEP-RS) for ventral and incisional hernias - early operative outcomes and technical remarks on a novel retromuscular approach.

INTRODUCTION: Incisional hernias can complicate up to one in four laparotomy procedures, and successful repair remains a significant clinical challenge for surgeons. Recently, the surgical technique of ventral hernia repair (eTEP-RS) has been introduced. AIM: To present early results in treating patients with ventral hernia using the eTEP-RS technique and to discuss key technical aspects affecting the safety and efficiency of repair. MATERIAL AND METHODS: A prospective study of early outcomes was conducted for all ventral hernia patients (hernia orifice between 4 and 8 cm) who underwent eTEP-RS between March 2019 and July 2020. RESULTS: As of July 2020, we performed a total of 11 eTEP-RS procedures. The mean duration of the surgery was 204 min (158 to 295). The average size of the treated defect in the transverse dimension was 5.8 cm, and the defect area was 38.5 cm2. The average size of the mesh used was 486 cm2 (280 to 590). After an average follow-up of 7 months (1-17) there was no recurrence or major complication. Based on our initial experiences we present a detailed description of the main aspects of the surgical technique itself, as well as the essential nuances, to enable evaluation of the technique and future popularization. CONCLUSIONS: The eTEP-RS technique is a safe alternative to open ventral hernia repair and allows for the placement of a large piece of mesh in accordance with current recommendations. Excellent knowledge of the detailed anatomy of the abdominal wall is essential for safe and effective hernia repair.

Psychological characteristics versus swallowing and speech rehabilitation efficiency in patients after oral cavity cancer excision.

Introduction: Personality traits of the patients surgically treated due to oral cancer form anxiety and depression levels associated with body deformation, as well as life quality during illness, and they are also associated with life span of the patients. It is purposeful to take personality traits into account during treatment management and rehabilitation of the patients. The aim of work is to recognize the association between personality traits and functional rehabilitation course in the patients treated due to oral cancer. Materials and methods: 100 patients (W ­ 42, M ­ 58; 55.78 ±11.68 years) surgically treated due to oral cavity squamous carcinoma. Patients participated in the rehabilitation of oral functions. Wound healing course, postoperative facial deformity, breathing, swallowing, and speech were assessed in relation to "self-image", "body image", and "the level of acceptance of the disease" according to the Adjective Check List ACL-37, Body Cathexis Scale, and Illness Acceptance Scale after 2, 4, and 12 weeks post-surgically. Results: Greater swallowing efficiency after 4 weeks post-surgically was present in patients with a stronger need for order and endurance. Patients who achieved greater speech efficiency in the 4th week post-surgically accepted their illness in a greater part. Patients in whom post-surgical deformity was greater showed lesser intensity in: achievements, domination, endurance, self-exposure, spontaneity in interpersonal contacts. These patients are characterized with lower self-reliance and greater need for counselling.

Compensatory Mechanisms in Patients After a Partial or Total Glossectomy due to Oral Cancer.

Excision of a part or the whole of tongue due to oral cancer disturbs swallowing and speech. Lower airways aspiration of the swallowed bolus in patients after such oral structures excision is a symptom of major swallowing disorder and may be the cause of aspiration pneumonia. Restoration of oral nutrition is possible after exclusion or reduction of aspiration threat in the patients. Video fluoroscopic evaluation of the swallowing performed at the beginning of the swallowing rehabilitation in 95 patients after a total or partial glossectomy due to oral cancer, who assessed their saliva swallowing as efficient on the day of examination, showed disturbances of all of the swallowing stages. The most common disturbances involved the oral stage: limited mobility of the oral tongue, impaired glossopalatal seal, and weak glossopharyngeal seal. The most serious among them involved pharyngeal stage of swallowing, as leakage into the larynx and aspiration. The patients used their own methods during barium suspension swallowing to facilitate the swallowing act. They used such methods as: changing the position of the head to the body, additional swallows, engaging the adjacent structures into sealing the oral fissure. We assumed that the compensatory mechanisms (CM) worked out by the patients before the swallowing examination will enable them efficient barium suspension swallowing. The CM were applied by 71 of 95 patients; 51 of the patients used more than one compensatory mechanism. Swallowing in 61 of the compensating patients was at least functional; swallowing in 10 of the compensating patients was non-efficient and caused recurrent aspiration. The results of our research negate the validity of multiple swallows (more than three) without apnea elongation because it may lead to aspiration. Aspiration was also recorded in patients with weak airways closure and immovable epiglottis, who complemented the impaired oral transport with gravitational oral transport by moving chin up during a swallow. The hypothesis that CM applied by the patients after oral cancer excision during saliva swallowing will be helpful in swallowing of the barium suspension was not proved. In 10 of all the patients recurring aspiration was found despite CM application. Determination of aspiration risk is the key to efficient swallowing rehabilitation. The assessment of CM applied spontaneously by the patients' maintenance validity is particularly important. Video fluoroscopic examination of swallowing allows to assess the aforementioned issue and is crucial for better comprehension of CM applied by the patients in creating a new swallowing pattern after oral cancer excision.

The role of the epiglottis in the swallow process after a partial or total glossectomy due to a neoplasm.

Repeatable epiglottic movement patterns were recorded during a videofluoroscopic swallow evaluation of 95 patients who had undergone a total or partial glossectomy due to a neoplasm. Because no epiglottic function assessment was performed preoperatively, for the purpose of this study it was assumed that epiglottic mobility was "normal" during this time and that all abnormalities found afterward resulted from the growth of the neoplasm and the glossectomy. It was noted that in the early postoperative period, absence of epiglottic movement was accompanied by aspiration and made swallowing incompetent in a majority of cases (9 of 10). A correlation of movement between the epiglottis and the extent of oral tissue excision was found. Epiglottic mobility was evaluated as "normal" in 72% of the patients, i.e., in 67 of 91 (74%) patients after a partial or nearly total glossectomy and in 1 of 4 people who underwent a total glossectomy. In the subgroup (16%) of patients who underwent a total or nearly total glossectomy and then had videofluoroscopic examinations, 60% of the cases had normal epiglottic movements and 40% had an immobile epiglottis. Compensatory mechanisms implemented by the patients on their own initiative, such as additional swallows and prolonged apnea during deglutition, enabled them to avoid aspiration. However, upward head movement and downward chin tilting during deglutition as compensatory mechanisms used by patients with no epiglottic movement did not reduce the aspiration risk in the early postoperative period and were found to accompany incompetent swallowing attempts.

Composite polyacrylate-poly(3,4- ethylenedioxythiophene) membranes for improved all-solid-state ion-selective sensors.

A novel type of self-plasticizing polyacrylate-based membrane was developed for all-solid-state ion-selective potentiometric electrodes. The membrane composition contains a conducting polymer (CP): poly(3,4-ethylenedioxythiophene) end capped with methacrylate groups, chemically grafted with the membrane during the photopolymerization step. This composition results in ion-selective membranes with the following advantages: lower electrical resistance compared to the CP-free membrane, facile ion-to-electron transduction between the membrane and the electrode support, controlled low activity of analyte ions, and high concentration of interferent ions (incorporated with the CP) within the membrane, potentially resulting in improved analytical parameters. Ca2+- and K+-selective membranes were chosen as model systems to study the effect of pretreatment and CP content on the potentiometric sensor's characteristics. For Ca2+ sensors, reproducible and stable Nernstian characteristics were obtained within the range from 0.1 to 10(-9) M CaCl2, without a time-consuming preconditioning step. For K+-selective sensors, the influence on Nernstian response range was observed for varying KCl concentrations in the conditioning solution, with the lowest detection limit found close to 10(-8) M KCl. Mass spectrometry coupled with laser ablation studies of the membranes revealed that in this case the detection limit is not related to primary ion content in the membrane contacting a sample solution, but is affected by interfering ion concentration close to the membrane surface.

[The tongue as a receptor and effector after tumor resection in the oral cavity]. / Jezyk jako receptor i efektor po wycieciu nowotworu jamy ustnej.

PURPOSE: To evaluate functional impairment in the oral cavity after resection of neoplasm. MATERIAL AND METHODS: 71 patients after partial or total glossectomy were examin ed to evaluate tongue mobility, superficial sensation, oral stereognosis and efficiency of deglutition. The extent of tongue resection, reconstruction procedures, tumor localization and the postoperative radiotherapy were taken into consideration. RESULTS: Excision of up to one-third of the mobile part of the tongue does not impair its function. Although longitudinal excision of half of the tongue with adjacent structures limits its mobility and sensory sensitivity, efficient deglutition is preserved. Despite extensive disturbances in mobility and sensory sensitivity of the tongue after transversal hemiglossectomy with adjacent structures, efficient deglutition is still achievable after rehabilitation. In the case of total glossectomy efficient deglutition also can be achieved after extended rehabilitation. This is also true for tongue reconstructed with a myocutaneous flap. CONCLUSIONS: Juxtaposition of limitations in sensorymotor functions with disturbances in deglutition after resection of tongue tumor facilitates understanding and prediction of these processes. Evaluation of deglutition efficiency after tongue reconstruction reflects effectiveness of rehabilitation.