Management of oculo-orbital complications of odontogenic sinusitis in adults.

Introduction: Odontogenic maxillary sinusitis (OMS) is an infectious inflammatory pathology caused by a dental condition. Considering the anatomical relations with the orbit, maxillary sinus infection can easily spread, evolving into severe oculo-orbital complications that can sometimes be life-threatening. Material and methods: We performed a retrospective study of over 2 years, examining the data of 18 patients diagnosed with OMS with oculo-orbital complications. The patients were evaluated regarding their dental history, symptoms, clinical and endoscopic findings, ophthalmologic evaluation, bacteriologic tests, computed tomography (CT) imaging, medical and surgical treatment, and outcomes. Results: The age of the patients was between 24 and 65 years old with an almost equal gender distribution: 10 female and 8 male patients. From the total, 7 patients had type II diabetes, 2 of whom were insulin-dependent, 1 patient had thrombophilia and 2 patients had renal failure with peritoneal dialysis. Regarding the type of oculo-orbital complications, 10 patients were diagnosed with preseptal cellulitis and 8 with orbital cellulitis. Just 5 patients with orbital cellulitis required surgical treatment and orbitotomy was performed, followed by endonasal endoscopic drainage. The evolution after surgical treatment was favorable for all operated patients. Discussions: Oculo-orbital complications of OMS are typically more severe than those of rhinogenic sinusitis because anaerobic bacteria are involved. Immunosuppression represents a favorable environment for the development of OMS and its complications, diabetes being the most common risk factor. A negative prognostic feature is the appearance of ophthalmological symptoms in both eyes, so visual function may be reduced. The treatment of oculo-orbital complications of OMS is urgent and depends on a broad-spectrum antibiotic therapy associated or not with surgical intervention. Conclusions: The diagnosis of oculo-orbital complications of OMS is complex and requires clinical experience as well as extensive medical knowledge to treat both the cause and the consequences of the conditions quickly and effectively. The proper management of oculo-orbital complications is based on a multidisciplinary team: ophthalmology, ENT, dentistry, imaging, and laboratory. Abbreviations: OMS = odontogenic maxillary sinusitis, CT = computed tomography, ENT = ear-nose-throat, MRI = magnetic resonance imaging, HNS = head and neck surgery.

Neutrophil-To-Lymphocyte Ratio and Systemic Immune-Inflammation Index-Biomarkers in Interstitial Lung Disease.

Background and objectives: The aims of the study were to evaluate the utility of neutrophil-to-lymphocyte ratio (NLR) and the systemic immune-inflammation index (SII) as inflammation markers and prognostic factors in patients with known interstitial lung disease secondary to connective tissue diseases (CTD-ILD) compared with idiopathic pulmonary fibrosis (IPF). Materials and Methods: Forty-two patients with known interstitial lung disease (21 with IPF and 21 with CTD-ILD) and 42 control matched healthy patients were included. The NLR was calculated as the absolute neutrophil count divided by the absolute lymphocyte count, and the SII was calculated as follows: SII = platelets × neutrophils/lymphocytes, with the data being obtained from the patients data charts at admission, before any treatment. Results: our hypothesis was that in patients with interstitial lung disease NLR and SII would have higher values compared with patients with CTD-ILD or control healthy patients. The mean NLR value was 3.01 (±1.35) among patients with idiopathic pulmonary fibrosis, and 2.38 (±1.08) among patients with CTD-ILD without significant statistical difference (p = 0.92). There was however a clinically significant statistical difference when compared with the control group, where NLR was 2.00 (±1.05) (p = 0.003). SII values were 619.37 (±329.51) in patients with IPF, 671.55 (±365.73) in CTD-ILD group and 569.73 (±326.67) in healthy subjects (p = 0.13) Conclusions: A mean NLR value of 2.8 and a SII value over 500 in patients with connective diseases can become a marker of pulmonary interstitial involvement. In the context of non-exacerbated interstitial lung disease, NLR and SII have reduced numerical values, without being statistically correlated with prognosis when we compared with patients with connective tissue diseases without exacerbation or with healthy people, the cut off being of 2.4. However subsequent studies in larger patient samples might provide changes in these cut-off values.

Ocular surface reconstruction in limbal stem cell deficiency.

The purpose of our review was to familiarize the readers with the new concepts in ocular surface diseases and reconstruction. Limbal stem cell deficiency is characterized by the progressive invasion of conjunctival epithelial cells onto the cornea, superficial vascularisation, destruction of the corneal basement membrane, and chronic inflammatory cell infiltration. Depending on the severity of the disease and the time passed from the primary injury amniotic membrane transplantation, keratolimbal allograft and autograft are the available treatments hoping that, in the nearest future, stem cell transplantation and tissue engineering will become the usual therapeutic choices.

XRCC3 Thr241Met Polymorphism is not Associated with Lung Cancer Risk in a Romanian Population.

BACKGROUND AND AIMS: Deoxyribonucleic Acid (DNA) repair mechanisms play a critical role in protecting the cellular genome against carcinogens. X-ray cross-complementing gene 3 (XRCC3) is involved in DNA repair and therefore certain genetic polymorphisms that occur in DNA repair genes may affect the ability to repair DNA defects and may represent a risk factor in carcinogenesis. The purpose of our study was to investigate the association between XRCC3 gene substitution of Threonine with Methionine in codon 241 of XRCC3 gene (Thr241Met) polymorphism and the risk of lung cancer, in a Romanian population. METHODS: We recruited 93 healthy controls and 85 patients with lung cancer, all smokers. Thr241Met, XRCC3 gene genotyping was determined by multiplex Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP). RESULTS: Statistical analysis (OR, recessive model), did not revealed an increased risk for lung cancer, for the variant 241Met allele and Thr241Met genotypes (p=0.138, OR=0.634, CI=0.348-1.157; p=0.023, OR=0.257, CI=0.085-6.824). Also, there were no positive statistical associations between Thr241Met polymorphism of XRCC3 gene, gender, tobacco and various histopathological tumor type of lung cancer. CONCLUSION: In conclusion, the results of the study suggest that the XRCC3 gene Thr241Met polymorphism is not associated with an increased risk for the development of lung cancer in this Romanian group.

The XRCC1 Arg194Trp polymorphism is significantly associated with lung adenocarcinoma: a case-control study in an Eastern European Caucasian group.

DNA repair plays an important role in maintaining the integrity of the genome by repairing DNA damage induced by carcinogens. Certain genetic polymorphisms that occur in DNA-repair genes may affect the ability to repair DNA defects, and may represent a risk factor in carcinogenesis. The gene XRCC1 is involved in DNA repair. The purpose of our study was to investigate the association between XRCC1 Arg194Trp and Arg399Gln polymorphisms and the risk of lung cancer in a Romanian population. We recruited 222 healthy controls and 102 patients with lung cancer. Genotypes were determined by multiplex polymerase chain-reaction restriction fragment-length polymorphism. Statistical analysis (odds ratio, recessive model) revealed an increased risk for lung cancer for the homozygous 194Trp genotype (χ (2)=0.186, odds ratio 10.667, 95% confidence interval 1.309-86.933; P=0.007). Also, we found an association between the 194Trp allele and women with lung adenocarcinoma. In conclusion, the results of the study place the XRCC1 Arg194Trp polymorphism among independent risk factors for developing lung cancer.

NEOVASCULAR SECONDARY GLAUCOMA, ETIOLOGY AND PATHOGENESIS.

RATIONALE: Neovascular secondary glaucoma is a condition characterized by increased intraocular pressure due to the neovascularization occurring at the iridocorneal angle and iris, the most common complication of end-stage ischemic retina. The early diagnosis and treatment of this disease are important, because the functional prognosis is reserved. OBJECTIVE: Knowing and understanding the etiology and pathogenesis of neovascular secondary glaucoma. METHODS AND RESULTS: Review of the angiogenesis theory to understand the etiology and pathogenesis of neovascular secondary glaucoma. VEGF is the most studied proangiogenic factor involved in the neovascular glaucoma pathogenesis. The 9 isoforms contain consensus signal sequences for extracellular secretion, all of them binding to a specific receptor subtype and stimulating tissue specific angiogenesis. VEGF and VEGF-m RNA levels are significantly increased in the ischemic retina. Diabetes mellitus (with diabetic retinopathy), central retinal vein thrombosis and repeated retinal detachments are diseases that cause neovascular glaucoma through ischemia. DISCUSSION: Correct evaluation of the iris neovascularization followed by a proper treatment is the most important in a case of secondary neovascular glaucoma. Repeated gonioscopy is indicated in cases with high risk of developing neovascular glaucoma. Close monitoring of a patient with high thromboembolic risk: valvular heart disease, open-heart surgery, other angioplasties.

[Pathology of the vitreomacular interface]. / Aspecte patologice ale interfetei vitreomaculare.

Vitreous role in the pathophysiology of retinal diseases has increased importantly over the recent years. This was possible using Optical Coherence Tomography which reviewed the way the vitreoretinal interface should be looked at and defined and classified new pathologies such as Vitreoretinal Traction Syndrome. Vitreous is not an empty space but an important anatomical structure with role in ocular physiology. With age biochemical changes occur so that vitreous starts to liquefy. Once the vitreous is liquefied (sinchisis) it collapses and passes in the retrohialoid space (sineresis). In complete PVD besides sinchisis there is a weakness of the adherence between the posterior cortex and ILM with total detachment of posterior cortex. Abnormal adhesions are associated with incomplete PVD. The definition and understanting of vitreoretinal pathology is an active and continuous process, PVD being the trigger of a lot of retinal pathologies: epiretinal membrane, macular hole, tractional macular oedema, VMTS, myopic traction maculopathy, exacerbations of exudative ARMD.

[Changes in intraocular pressure depending on posture]. / VARIATII ALE PRESIUNII INTRAOCULARE ÎN FUNCTIE DE POZITIA CORPULUI.

UNLABELLED: Glaucoma is an important eye disease that, left untreated, causes irreversible blindness by affecting optic nerve threads. Decreasing intraocular pressure and maintaining it at a low level throughout the day is one of the objectives of antiglaucoma therapy. METHODS: This is a prospective study conducted on a sample of 80 patients who presented at "Emergency Eye Hospital" Bucharest between 1st of December 2013 30th of July 2014. Patients were divided into two groups: 40 patients with glaucoma and 40 patients without glaucoma (control group). THE OBJECTIVE OF THE STUDY: To determine changes in intraocular pressure that may occur depending on body posture and the correlations between changes in intraocular pressure and glaucoma, obesity, hypertension. These IOP changes may be important in the progression of glaucoma regarding that one third of our time is spent on supine position during night. RESULTS AND CONCLUZIONS: IOP varies from sitting down to supine position. IOP increases in supine in most patients (with or without glaucoma) with an average of 1.25 mmHg. The increase among patients with glaucoma is higher (1.67 mmHg) compared to those without glaucoma (0.82 mmHg). In patients with hypertension and glaucoma, IOP increased with 2.62 mmHg. In patients with hypertension and obesity IOP increased with 2.5 mmHg.

Intratracheal fiber glass instillation in rats: IL8 and lymphocytes levels in bronchoalveolar lavage, correlation with the histopathological findings.

INTRODUCTION: Fiberglass (FG) is the largest category of man -made mineral fibers. Many types of FG are manufactured for specific uses building insulation, air handling, and sound absorption. Because of increasing use and potential for widespread human exposure, a chronic toxicity instillation study was conducted in Wistar rats, which were found to be sensitive to the induction of mesotheliomas with another MMVF. AIM: The present study is focused on the effect of fiber glass on lung through intratracheal exposure, the analysis of bronchoalveolar lavage and measurement of IL 8 levels, lymphocytes number and histopathological finding after the exposure period. MATERIAL AND METHOD: Four groups of 8 female Wistar rats were included in the study. The animals were divided into three groups of 8 each, exposed to different doses of FG and one control group. The first group (1-8) was exposed to 6 mg dose/0.2 ml saline 5 days/week for 10 weeks, the second (9-16) group was exposed to 10 mg/0.2 ml saline 5 days/week 10 weeks, the third group (17-24) was exposed to 12 mg FG/0.2 ml saline solution 5 days/week 10 weeks and the control group (25-32) was exposed to the same volume of saline. The fibers had been size selected to be rat respirable. At the end of the exposure period of 10 weeks the rats were killed one week after the last exposure. Following preparation of the lungs, they were lavaged with 2x5 ml saline without massage. The lavage fluid was collected in calibrated tubes and harvested volume was recorded. Supernatant was obtained after centrifugation at 1,500 r.p.m for 5 minutes and IL8 levels and lymphocytes number were measured. RESULTS: The IL8 levels were found to be dose related; the first group had values ranging from 10 to 19.8 pg/ml and the total lymphocytes number in the bronchoalveolar lavage fluid ranging from 1,500-1,900 and minimal/slight inflammatory lesions. The second group had the IL8 levels ranging between 60.4-80.4 pg/ml, lymphocytes number between 680-881 and moderate to marked inflammatory lesions. For the third group the IL8 values ranged between 88.3-113.2, the lymphocytes number ranged between 241-342 and the histopathological findings were marked and severe including emphysema, lung and pleural fibrosis. The control group had IL8 values between 10-19.4, there were no lymphocytes in the bronchoalveolar lavage and no histopathological findings. CONCLUSION: These findings indicate that IL8 levels were dose related and IL8 levels have an inverse correlation with lymphocytes count in BAL, also correlated with the histopathological findings for the studied groups.

Assessment of health effects related to fiber glass exposure in fiber glass workers: exhaled biomarkers eCO, FENO and their usefulness in the occupational environment testing.

INTRODUCTION: Numerous epidemiological animal model studies have been conducted in order to assess the health effects of man-made vitreous fibers. They have been shown to be responsible for producing lung fibrosis and lung and peritoneal cancer in animal models. A few large cohort studies were conducted in Europe and the US to assess the health effects of fiber glass in production workers and a higher cancer incidence was evidenced. AIM: The aim of the study is to assess the usefulness of exhaled biomarkers measurements: exhaled nitric oxide and exhaled carbon monoxide in fiber glass workers as indicators of an inflammatory airway response. MATERIAL AND METHOD: A total of 42 fiber glass workers were included in this study with a minimum of 5 year exposure period in which FENO and eCO values were measured. Also spirometry chest X ray, C reactive protein, fibrinogen, total IgE serum and IL8 serum levels were determined. RESULTS: Increased values of exhaled nitric oxide (over 25 ppb) were found in 43% of the fiber glass workers and increased values of exhaled carbon monoxide (over 6 ppm) were determined in 26% of the fiber glass workers. A positive correlation was found between the exposure period and FENO values and total IgE values (p<0.05). A negative correlation coefficient was found between FEF 25-75 predictive values and FENO and total IgE values. CONCLUSION: These results suggest that exhaled biomarkers can be useful to assess an inflammatory airway response in the occupational environment.

[Artificial drainage devices--history, indications]. / Sisteme artificiale de drenaj, istoric, indicatii.

Glaucoma is a degenerative optic neuropathy progressive, multifactorial, which can lead to blindness. Blindness in patients with glaucoma is defined as visual field reduction below 10 degrees. Artificial drainage systems are a solution for refractory to medication, laser treatment or conventional surgery. Used by over 100 years, improved with good surgical technique and careful patient follow-up surgery, postoperative results are satisfactory.

Churg Strauss syndrome associated with montelukast--case report.

Churg-Strauss Syndrome (allergic granulomatous angiitis) is a rare systemic and pulmonary vasculitis. We report the case of a 62 years old female, non-smoker, with a 20 years history of moderate persistent asthma treated with Salmeterol/Fluticasone 50/500 microg bid for 5 years and supplemental Montelukast in the past 5 months. The patient was admitted in our hospital with fever, malaise, sensory deficits in the lower extremities, diffuse musculoskeletal and thoracic pain. Blood eosinophil was 38% of her total WBC, thoracic computed tomography evidenced ill-defined groundglass attenuation predominantly involving the lateral segment of the middle lobe. Pulmonary infiltrates with eosinophilia can be used to define eosinophilic lung diseases. We made the differential diagnosis of eosinophilic lung disease: acute or chronic eosinophilic pneumonias, allergic bronchopulmonary aspergillosis, Loffler syndrome, Churg-Strauss syndrome, bronchocentric granulomatousis, idiopathic hypereosinophilic syndromes. Bronchoalveolar lavage showed 14.6% eosinophils. Few days after hospital admission patient experienced nausea, vomiting and diarrhea. She underwent a digestive endoscopy, which showed eosinophilic enteritis according to colon biopsy. Nasal mucosa biopsy found granulomas. Anti-neutrophil cytoplasmatic antibody (ANCA) was positive at 1:20. She displayed more than four American College of Rheumatology (ACR) criteria for Churg-Strauss Syndrome (developed while she was receiving montelukast therapy). Discontinuation of Montelukast and association of oral prednisone (1 mg/kgc) induced rapid improvement of symptoms and rapid decrease of peripheric eosinophils (72 hours). This case report illustrates the importance of early diagnosis of Churg-Strauss syndrome and the possible pathogenic link between leukotriene receptor antagonist use and CSS development.

[Artificial drainage systems: Ahmed valve, surgical technique]. / Sisteme artificiale de drenaj, valva Ahmed; tehnica de implantare.

Despite many therapeutic options, some glaucomas remain refractory to treatment and intraocular pressure remains elevated or there is a progression in visual field. When conventional therapies and operations fail or the theoretical chances of success are low (for example, neovascular glaucoma), implantation of an artificial drainage device system is used as a last resort. Artificial drainage systems create a link between inside and outside the eye and lower intraocular pressure. Characteristics of Ahmed valve, Surgical technique.

[Why do doctors smoke?]. / De ce fumeaza doctorii?

Smoking prevalence is decreasing in developed countries in the last decades. Nevertheless, there is a constant increase of morbidity and mortality of smoking-related diseases (COPD, asthma, respiratory infections, cardiac diseases, cancer). Then why do doctors smoke? Because they experimented in adolescence and college and the addiction developed fast, while information about smoking risks arrived too late. Five hundred questionnaires were distributed to 100 doctors and 400 students between March-April 2009; 50% were returned from the doctors and 90.5% from the students. We analyzed comparative the smoking status (60% non-smoking doctors and 56.9% non-smoking students. Mean age was 25.05 for doctors and 24.2 for smoking students. Mean starting age was 17.13 years, 17.78 respectively. They were asked about major components of cigarettes, main diseases induced by smoking, the effects of nicotine addiction, known laws and projects, the need for introducing in the university curricula of anti-smoking modules. 20% of the doctors and 14.5% of the students had a smoking-related disease. 52% of doctors and 57% of students supported forbidding smokingin public spaces, 13.7% of doctors and 88.9% of students supported the increase of cigarettes price, and only 48% of doctors and 47% of students suggested the need of help for smoking cessation. We noticed there are flaws in knowledge of extra pulmonary diseases in students as well as doctors. Most respondents had lacking, non-systematic information and 96% of doctors and only 69.6% of students consider useful tabaccology lectures. For stopping epidemic morbidity and mortality due to smoking related diseases, there is need for involving all those working in health programmes. For this, medical schools should do better in preparing specialists. We also consider it is time that all medical specialties should consider smoking cessation a priority, while the pneumologists should sustain a systematic and routine activity against smoking.

[Primary antiphospholipid syndrome]. / Sindromul antifosfolipidic primar.

Antiphospholipid syndrome (APS) is a disorder characterised by recurrent arterial or venous thrombosis and/or pregnancy losses, in the presence of persistently elevated levels of anticardiolipin antibodies and/or evidence of circulating lupus anticoagulant (these abnormalities are detected by blood tests). Primary APS occurs when there is no evidence of associated diseases. APS in the presence of an underlying disease, usually systemic lupus erythematosus, is called secondary APS.

[Tuberculosis or sarcoidosis]. / Tuberculoza sau sarcoidoza?

Tuberculosis and sarcoidosis are two different diseases with different etiology, clinical features and treatment. Both are granulomatous disease, but tuberculosis has a caseating necrosis granuloma as opposed to sarcoidosis witch present noncaseating epithelioid cell granuloma. If chest radiography shows hilar lymphadenopathy and hystopatological features reveal no caseating necrosis granuloma the differential diagnosis might be difficult. This is a case of abdominal adenopathy in a 39-years-old male, with a past medical history significant for pulmonary tuberculosis. The patient was admitted to the hospital for mild epigastric pain and weight loss (14 kg for the last year). The abdominal ultrasound and CT scan revealed retroperitoneal lymph node enlargement. Chest X-ray revealed bilateral hilar adenopathy and mediastinal adenopathy. After various differential diagnoses were considered, a diagnostic laparoscopy and a lymph node biopsy were performed. The pathology report showed chronic necrotizing granuloma. The case was interpreted as lymph node sarcoidosis and treated with corticosteroids (Prednisone). After one month of treatment the patient complained of dry cough, night sweats, fatigability, decreased appetite and weight loss. Pathological findings of chest radiography and CT scan with iv contrast (left upper lobe infiltrate, right lower lobe ill-defined mass, multiple small nodular opacities scattered throughout both lung fields, bilateral hilar and mediastinal adenopathy, lymph nodes near celiac trunk were enlarged) and positive acid-fast bacilli of sputum smears point to the real diagnosis of pulmonary tuberculosis and abdominal lymph nodes tuberculosis. The patient was started on a daily treatment with Isoniazid, Pyrasinamide, Ethambutol, Streptomycine, Cyprofloxacine, Cicloserine and Protionamide (he was allergic to Rifampin). Five months later the clinical and radiological findings were almost normal and the sputum smear for acid-fast bacili was negative.

[Ophthalmological involvement in rheumatic disease]. / Aspecte ale afectarii oftalmologice in bolile reumatice.

PURPOSE: The main objective of this study was to identify the prevalence of ocular manifestations in rheumatic patients admitted in a specialized clinic. METHODS: Information regarding rheumatic and ocular diseases was extracted from medical records system available in "Dr. I. Cantacuzino" Clinical Hospital from Bucharest. The prevalence of ocular involvement reported passively by rheumatologists (retrospective descriptive study of 375 different cases of rheumatic patients) was compared with the literature data. RESULTS: There were 45 cases of ocular manifestations. Keratoconjunctivitis sicca was noted in 16 patients with rheumatoid arthritis, two patients with systemic lupus erythematosus and one patient with scleroderma. Anterior uveitis was found in seven patients with ankylosing spondylitis, one patient with reactive arthritis, two patients with psoriatic arthritis and one patient with LES. Conjunctivitis was present in two patients with reactive arthritis. In LES ocular involvement also included four cases of retinal vasculitis. Complications clearly related to steroid therapy were nine cases of cataracts. One case with typical "bull's eye" maculopathy due to Hydroxychloroquine treatment was detected. CONCLUSIONS: The main conclusion of our study is that the rheumatic patients need to be referred to an ophthalmologist for the diagnosis and the optimal treatment of ocular involvement.

Vascular tumors in the orbit--capillary and cavernous hemangiomas.

Vascular tumors in the orbit result from new formation of vessels, proliferation of tissue components of the vessel wall, and hyperplasia of cellular elements ordinarily concerned with the genesis of vascular tissue. These vasculogenic lesions constitute the largest group of primary orbital tumors; we present the capillary hemangioma and the cavernous hemangioma.