C-reactive protein concentration as a prognostic factor for inflammation in the management of odontogenic infections.

Our aim was to find out if it is possible to correlate the duration of stay in hospital, the severity of infection, involvement of particular anatomical spaces, white cell count, efficacy of surgical treatment, and fever with C-reactive protein (CRP) concentrations on admission. One hundred patients met our inclusion criteria. After their notes had been examined they were subdivided according to whether the infection of the main facial space involved was less severe, moderately severe, or very severe. The relations between degree of severity and CRP concentration on admission (<100mg/L compared with 100+), age (years), sex, and duration of hospital stay (days) were examined using Poisson regression (because the distribution of characteristics, and particularly the duration of stay, were skewed). The overall model was significant (p=0.003). Pearson and deviance chi square tests did not indicate overdispersion (p=0.97 in both cases), which suggested that the assumptions about the Poisson distribution were valid. Log-rank chi square tests indicated that only severity had a significant effect (p=0.0001), and C-reactive protein concentration was not significantly associated with group on admission, age, or sex. The moderately and very severe groups had longer median (range) durations of stay than the less severe group (5 (2-8) compared with 3 (1-8) days, respectively). CRP concentration was not a prognostic factor for the extent of odontogenic infections or presumed duration of stay, but severity scoring was a significant factor in the prediction of duration of stay in hospital.

[Rare presentation of acute myeloid leukemia in head and neck area, differential diagnosis and a case presentation].

Differential diagnosis of lateral neck masses is vast, it may be one of many possible pathologies, it may appear in any age group and could be a presentation of a congenital, inflamed or a reactive structure, salivary gland pathology and of a traumatic or an latrogenic origin. Neck mass in adults of 40 years old or older require an immediate attention, the primary concern is of a metastatic dissemination of a local or a distant primary malignancy, in 74% the primary is local and in 11% distant. A 43 years old male, otherwise healthy, was admitted to the ER with a chief complain of a right submandibular mass, presenting over 3 weeks. Prior to addmition he was initially mistreated for odontogenic abscess by extraction of inflamed teeth in right posterior mandibular segment and an antibiotic regime by augmentin and metronidazole, with no resolution. On admission he presented an abnormal blood count, with a severe leukopenia, thrombocytopenia and neutropenia. A bone marrow biopsy has shown a massive infiltration of myeloid blast cells, consequently he was diagnosed with Acute Myeloid Leukemia, and the lateral neck mass was clinically diagnosed as a Chloroma.

[Type B intramural hematoma rupture].

A 70-year-old male, who had complained sudden chest pain and sweating, was admitted to our hospital and diagnosed as a type B intramural hematoma rupture. Emergency repair was performed with arch replacement and open-stent method. Post-operative recovery was satisfactory and the patient was discharged. A type B intramural hematoma rupture is relatively rare. Trans-esophagial echocardiography is quite useful to detect the aortic lesion and to determine the ideal depth of the stent-graft.