Parents’ versus Grandparents’ Attitudes about Childhood Vaccination

Background: We investigated and compared practices and attitudes about childhood vaccination between young parents and their parents and identified influences and sources of information in the County of Zadar, Croatia. Methods: This research was conducted in six general practice and paediatric medical clinics. It included 300 volunteers, including 150 younger parents and 150 older grandparents. Information was collected with a survey questionnaire. The survey data were statistically processed. Results: The 300 participants were divided into 2 groups. Most of the respondents were married, employed, had a high school education, and had a good economic status, often with two children and living in the city. Generally, the attitude towards vaccination was positive. Healthcare workers made the most important influence on the decision for vaccination. The younger age group was significantly affected by social networks and the internet and wanted more information. They were afraid of the adjuvants in vaccines. The older respondents held that vaccination must be legally regulated and did not believe the anti-vaccine media headlines. Conclusions: Our respondents had positive attitudes towards childhood vaccination, noticed the benefits of vaccinating children, and held that untreated children represent a risk for the community. They were well informed and satisfied with the collaboration with medical professionals, although the media and social networks had some impact on attitudes.

Patho-Anatomic Spectrum of Branchial Cleft Anomalies: Proposal of Novel Classification System

PURPOSE

Histogenesis, nomenclature, and classification of branchial cleft anomalies (BCAs) have been subjects of controversy for decades. The purpose of this study was to investigate the accuracy of current developmental theories (congenital, lymph node, and hybrid branchial inclusion theories) in defining the anatomic and histopathological characteristics of BCAs.

METHODS

Ninety consecutive patients with BCAs who underwent surgical excision were enrolled in this 2-center retrospective cohort study.

RESULTS

The present study included 90 patients: 46 (51.11%) women and 44 (48.89%) men (P > .05). The mean age at presentation was 31.89±17.31 years. Altogether, 92 BCAs were identified within the study population including 49 (53.26%) on the left side and 43 (46.74%) on the right side (P > .05). The BCAs included 79 (85.87%) branchial cleft cysts, 11 (11.96%) branchial cleft sinuses, and 2 (2.17%) branchial cleft fistulae. Three (3.26%) BCAs were distributed in the head regions, 88 (95.65%) in the neck regions, and 1 (1.09%) in the thoracic cavity. Following surgery, lymphoepithelial tissue was detected in the histopathological examination in 83 (90.22%) BCAs. The hybrid branchial inclusion theory exhibited significantly higher accuracy in defining patho-anatomic characteristics of BCAs than the branchial apparatus, precervical sinus, thymopharyngeal, and inclusion theories (90.22, 9.78, 2.17, 0.00, and 0.00%; respectively) (P < .05).

CONCLUSION

The novel branchial node (BN) classification system based on the hybrid branchial inclusion theory appears to be superior to other classification systems in determining the patho-anatomy of BCAs.

Tumor angiogenesis as an important prognostic factor in advanced non-small cell lung cancer (Stage IIIA)

The aim of the present study was to evaluate angiogenesis by determining the micro vascular density (MVD) and the expression of vascular endothelial growth factor (VEGF-A) in advanced non-small cell lung cancer (NSCLC) tumor samples, and to analyze their associations with clinical parameters and survival. Tumor tissue specimens of fifty patients (41 males and 9 females), who underwent radical surgical treatment for NSCLC in stage IIIA (T1-3N2) were collected for immunohistochemical analysis. MVD evaluation was performed using an anti-CD31 monoclonal antibody and VEGF-A expression using a polyclonal anti-VEGF-A antibody. The results were associated with two-year survival. Statistical analysis revealed significant associations in the level of angiogenesis (high MVD) and shorter survival of patients with NSCLC (P=0.0007). VEGF-A expression showed no association with micro vascular density (P=0.51) or survival (P=0.68). There was no significant association between MVD and VEGF-A. The measurable, clinical MVD parameters could be used as a reliable prognostic factor for the survival of patients with advanced NSCLC.

Sinus septi nasi: Anatomical study

The aim of this study was to perform a pioneering investigation into the incidence of pneumatization in human skulls. A total of 93 human skulls (≥20 years of age, 69 males, 24 females) were included in the study. The skulls were scanned in a fixed position using cone beam computed tomography (CBCT). The pneumatized space parameters within the nasal septum-width, length, and height-were measured. Two types of finding were identified: (a) Pneumatization, named "sinus septi nasi" (SSN), and (b) "spongy bone" (SB). The results showed SSN in 32 of the 93 skulls (34.4%). The SSN formations were from 0.5 to 4.2 mm wide, 3.5 to 18.8 mm long, and 3.8 to 17.7 mm high. Tumefactions filled with SB were found in 61 of the 93 skulls (65.59%). These were not suitable for precise measurements since the outer borders were not strictly and well defined on CT scans (perhaps because of the preparation process). In conclusion, the perpendicular plate of the ethmoidal bone is not always compact bone; in 34.4% of cases, it shows a degree of pneumatization. In contrast, an enlarged formation filled with SB is present in 65.59% of cases. The possible sources of pneumatization of this little-investigated region are discussed: sphenoid sinus, frontal sinus, and vomeronasal organ. Clin. Anat. 30:312-317, 2017. © 2017 Wiley Periodicals, Inc.

Endonasal endoscopic resection of ossifying fibroma involving the ethmoid sinus, orbit and anterior skull base: case report and literature review

Ossifying fibroma is a benign fibro-osseous tumour that rarely involves the ethmoid sinuses and orbit. It is classified as a benign fibroosseous lesion, a term that is synonymous with a variety of lesions reported in the literature. Recurrence rate with deleterious effects in cases of extramandibular ossifying fibroma is the impetus for open en bloc resection of the tumour. Continuously evolving techniques in endonasal endoscopic sinus surgery has rendered resection of large benign sinonasal and cephalonasal tumours possible. The authors report a case of ossifying fibroma involving the ethmoid sinus, orbit and anterior skull base in a 65-year-old previously healthy woman completely resected by endonasal endoscopic sinus surgery. The patient was free from postoperative complications and was dismissed from hospital on the sixth postoperative day. At present, the patient is disease-free at a regular five-year postoperative follow-up. Endonasal endoscopic resection of sinonasal ossifying fibromas is an excellent therapeutic option when performed by a surgeon experienced in endoscopic sinonasal surgery. The advantages of an endonasal endoscopic approach include direct visualization, enhanced visibility and magnification resulting in decreased intraoperative and postoperative morbidity. Aesthetic outcome is excellent in the absence of facial scars.

Lamb’s head: The model for novice education in endoscopic sinus surgery

Structured training in endonasal endoscopic sinus surgery (EESS) and skull base surgery is essential considering serious potential complications. We have developed a detailed concept on training these surgical skills on the lamb’s head. This simple and extremely cheap model offers the possibility of training even more demanding and advanced procedures in human endonasal endoscopic surgery such as: frontal sinus surgery, orbital decompression, cerebrospinal fluid-leak repair followed also by the naso-septal flap, etc. Unfortunately, the sphenoid sinus surgery cannot be practiced since quadrupeds do not have this sinus. Still, despite this anatomical limitation, it seems that the lamb’s head can be very useful even for the surgeons already practicing EESS, but in a limited edition because of a lack of the experience and dexterity. Only after gaining the essential surgical skills of this demanding field it makes sense to go for the expensive trainings on the human cadaveric model.

International study of the incidence of particular types of septal deformities in chronic rhinosinusitis patients: the outcomes from five countries

BACKGROUND

Chronic rhinosinusitis (CRS) may be more frequent in patients with particular types of septal deformities. The aim of this article was to investigate the incidence of particular types of septal deformities in adult CRS patients and healthy volunteers in various countries to determine whether some of them are more frequent in those groups.

METHODS

This international multicentric study involved 505 subjects from five countries: Croatia, Romania, Italy, Russia, and Turkey. The types of septal deformities were observed and grouped according to the Mladina classification. Subjects were examined by means of native anterior rhinoscopy, anterior rhinoscopy after decongestion, and fiber endoscopy with topical anesthesia. CRS patients have been diagnostically proved by computed tomography scanning of the paranasal sinuses.

RESULTS

Considering the CRS patients, the prevalence of so-called vertical deformities (types 2, 3, and 4) was seen. Among them, type 3 deformity was found most frequently in Turkey, Croatia, Italy, and Romania.

CONCLUSION

Type 3 deformity has been found frequently in CRS patients in all five of the countries. Russian subjects exhibited a high frequency of type 4 deformity. Because this type consists of types 2 and 3, the later, again, has been proven to be prevalent in CRS patients also in this group of patients.

Clinical Implications of Nasal Septal Deformities

The first attempts to systematize septal distortions have been given by Cottle who defined four groups of septal deformities: subluxation, large spurs, caudal deflection and tension septum. Fortunately, the variations of the septal deformities show a certain order, thus enabling more precise classification. Mladina was the first to make user-friendly classification of septal deformities in six basic types. He also described the seventh type, named "Passali deformity", which presents individually, but is always a well-defined combination between some of the previous six types. Mladina types of septal deformities (SD) are divided in two main groups: so called "vertical" deformities (types 1, 2, 3 and 4), and "horizontal" ones (types 5 and 6). This classification was immediately well accepted by rhinologists worldwide and started to be cited from the very beginning. Since then it has been continuously cited increasingly more often, thus making Mladina classification a gold standard whenever clinical researches on nasal septum are concerned. More than forty clinical studies based on this classification have been performed to date. It is extremely important to make a strict distinction between the types of SD since all of them play some specific role in the nasal and general physiology in man.

Training cerebrospinal fluid leak repair with nasoseptal flap on the lamb's head

BACKGROUND

One of the major challenges of cranial base surgery is reconstruction of dural defects and cerebrospinal fluid leak closure. Various grafting methods have been used for smaller skull base defects with great success. The indications for endoscopic reconstruction have recently evolved to encompass much larger breeches in the skull base following tumor removal, thus emphasizing the need for vascularized tissue flaps for reconstruction.

METHODS

Some authors proposed a pedicled flap of the nasal septum mucoperiosteum and mucoperichondrium, which is very vascularized and has quite a large surface. It is also long enough to easily cover even larger defects of the skull base. The elevation of a nasoseptal flap is based on a particularly advanced surgical technique and thus requires proper training before being performed in a real patient.

RESULTS

Anatomical differences between human and lamb heads were observed and explained although they do not affect the procedure of the elevation of the nasoseptal flap.

CONCLUSIONS

The lamb's head has been shown to be an ideal model for the adequate training of the surgical skills required for this demanding procedure.

Influence of the menstrual cycle on the incidence of nausea and vomiting after laparoscopic gynecological surgery: a pilot study

STUDY OBJECTIVE

To investigate whether the phase of menstrual cycle influences the incidence of postoperative nausea and vomiting (PONV) in women undergoing general anesthesia for elective laparoscopic gynecological surgery.

DESIGN

Prospective, observational, blinded study.

SETTING

General hospital, Postanesthesia Care Unit, and gynecologic floor room.

PATIENTS

111 ASA physical status 1 and 2 women, aged 18 to 53 years.

INTERVENTIONS

Patients were classified into three groups according to the phase of menstrual cycle at the time of anesthesia: Group F1: follicular phase (menstrual days 1-8; n = 34); Group O2: ovulatory phase (days 9-15; n = 40); and Group L3: luteal phase (days 16 to end of cycle; n = 37). Anesthetic, postoperative pain management, and antiemetic regimens were standardized.

MEASUREMENTS

Frequency of nausea, vomiting, or both were assessed for early (0-2 hrs). Late PONV (2-24 hrs) along with the use of rescue antiemetic, severity of nausea, and pain.

MAIN RESULTS

In the follicular (n = 34), ovulatory (n = 40) and luteal phase (n = 37) groups, the frequencies of PONV over 24 hours were 35%, 38%, and 14% (P = 0.04), respectively. This was due to differences in the early postoperative period where the frequencies were 21%, 25%, and 3% (P = 0.02), respectively, as frequencies were similar in the late period (15%, 20% and 14%, P = 0.71), respectively. Nausea scores, rescue antiemetic usage, pain scores, and opioid consumption were similar in the groups.

CONCLUSION

Patients in the luteal phase of their menstrual cycle may have a decreased risk of PONV after laparoscopic gynecological surgery in the early postoperative period.

Two holes syndrome (THS) is present in more than half of the postnasal drip patients?

CONCLUSION

Posterior fontanelle defects were found in almost half of the patients with postnasal drip and in a negligible number in the cohort of healthy subjects.

OBJECTIVES

The aim of this study was to compare the incidence of fontanelle defects in patients with postnasal drip and in healthy subjects.

MATERIALS

A total of 723 outpatients suffering from postnasal drip as a leading symptom were examined during the last 10 years by means of nasal fiberendoscopy. The authors were searching for defects in the posterior fontanelle region and recirculating mucus. The control group consisted of 312 healthy volunteers with no history of postnasal drip.

RESULTS

The defect in the posterior fontanelle was found in 414 of 723 patients with postnasal drip (57.3%). It was bilateral in 238 of 414 cases (57.5%). The defect in the anterior fontanelle was not found in this cohort at all. The recirculating mucus ring was clearly identified in 107 of 414 patients (25.8%). The defect in the posterior fontanelle was found in only 7 of 312 healthy volunteers (2.2%) (p < 0.01).

A biofilm exists on healthy mucosa of the paranasal sinuses: a prospectively performed, blinded, scanning electron microscope study

OBJECTIVES

Based on our hypothesis that biofilm is nothing else but normal, otherwise abundantly colonised mucosal mucous blanket, the aim of this study was to check out whether bacterial biofilm exists exclusively at the diseased mucosal surfaces or at healthy mucosa of paranasal sinuses as well.

DESIGN

Prospective and blinded.

SETTING

Tertiary academic hospital.

PARTICIPANTS

The patients suffering from the diseases not related to the chronic inflammation of the paranasal sinuses. Mucosal tissue samples from healthy sphenoid sinuses were taken from 48 patients who underwent pituitary gland surgery and from ethmoidal sinuses mucosa of the 17 patients who underwent endonasal endoscopic orbital decompression because of Graves' disease.

MAIN OUTCOME MEASURES

The samples were submitted blindly along with similar samples from patients with chronic rhinosinusitis to two scanning electron microscope experts. In all samples the looked for the main signs of biofilm presence of: the 'towers', rod-shaped bacteria and water channels.

RESULTS

Signs of biofilm presence were found in 45 out of 48 pituitary gland surgery patients (94%) and in all of 17 EEOD patients (100%).

CONCLUSIONS

Our study showed the presence of the biofilm at the surface of the healthy mucosa of the paranasal sinuses. This suggests that perhaps so called bacterial biofilm is nothing else but regular respiratory mucosal blanket, a part of the mucociliary system itself, containing a great number of bacteria.

Biofilm--the other name for the regular mucosal blanket

Bacterial biofilms have been found in many human bacterial infectious processes including chronic rhinosinusitis. It was found also at the surface of nasal polyps, and both at the surface of the nasal part and the stalk of the antrochoanal polyp. However, our recent research clearly demonstrated the presence of the biofilm at the surface of the mucosa of the healthy paranasal sinuses as well. Our hypothesis therefore is that the biofilm in the nose and paranasal sinuses is nothing else but regular respiratory mucosal blanket, a part of the mucociliary system itself, containing variable number of bacteria.

Septal mucoperiosteal flap for the repair of unilateral choanal atresia

The authors present a new modality of endoscopic repair for unilateral choanal atresia. A 14-year old girl complained of right-sided nasal obstruction. Endoscopy and CT scans showed unilateral bony choanal atresia. The patient underwent endoscopic endonasal surgery. A mucoperiosteal flap at the posterior part of the septum in the left, healthy nasal cavity was fashioned and the denuded part of the septum was removed. The atretic choanae was resected and a unified posterior nasal opening was formed. The flap was spread over the posterior septal edge and adjusted to the opposite septal side. One-year follow-up of the patient showed no stenosis of the choanae.

Island composite nasal flap for nasal dorsum skin defects

BACKGROUND

Skin defects on the nasal dorsum remain a challenge for the plastic surgeon. There are few local nasal flap options for the repair of proximally positioned nasal skin defects.

METHODS

During a 3-year period, 22 patients were treated after excision of skin cancer in the proximal two-thirds of the nose. Nine patients (41%) were female and 13 (59%) were male, with an average age of 69 years. All patients were operated on under local anesthesia. The average follow-up was 25 months.

RESULTS

In all patients, after tumor ablation, the skin defect was closed with an island composite nasal skin flap. Pathohistologic analysis confirmed that the margins of the removed tumor were free of malignant cells. Six patients (27.3%) had squamous cell and 16 (72.7%) had basal cell carcinoma. There was no total or partial flap loss. None of the patients has suffered from recurrence of the tumor.

CONCLUSIONS

The island composite nasal flap is a reliable technique for the closure of proximal nasal skin defects. Complications in the elevation of the island composite flap were rare, and the final result was acceptable.

Unilateral cleft lip/palate children: the incidence of type 6 septal deformities in their parents

BACKGROUND

The overall incidence of pathological septal deformity has been found to be significantly higher in unilateral cleft lip/palate (UCLP) children than in control children. Of the seven types of septal deformity according to Mladina's classification, type 6 has been found to be the most frequent in UCLP children, occurring in only 3.7% of the control children.

OBJECTIVE

To investigate the incidence of type 6 septal deformity in the parents of UCLP children.

PATIENTS AND METHODS

UCLP children (N=62) and their parents (N=91) were examined for type 6 septal deformities.

RESULTS

Type 6 was found in at least one parent of a UCLP child in 58% of cases. However, it was not found in the parents whose UCLP children did not show a type 6 septal deformity.

CONCLUSION

Type 6 septal deformity is almost a rule in children suffering from UCLP. Type 6 was not seen in the parents whose UCLP children did not show a type 6 septal deformity. There is a morphogenetic predisposition for the development of CLP in children whose parents carry a type 6 septal deformity.

[Pharynx and cervical esophagus reconstruction with pectoralis major flap]

Among numerous myocutaneous flaps, pectoral major flap is most frequently used in oncological head and neck surgery. It is specially frequent in oral cavity reconstruction, but quite rare in hypopharynx and cervical esophagus reconstruction. Nine patients had squamous cell carcinoma of the oropharynx or hypopharynx with propagation to hypopharynx and/or external larynx. Resection of malignant tumor and defect reconstruction of the pectoral major flap were done in one act. Two patients had the entire oropharynx, hypopharynx, and the cervical part of the esophagus reconstructed, whereas another seven patients had only the hypopharynx and cervical part of the esophagus reconstructed. The pectoral major flap reconstruction was done in three ways: by making a parasternal skin island with tubulous in situ formation (N = 4), with spiral formation of tubulous--Ryan method (N = 1), and by distally making a skin island in the rectangular form and tubulous in situ formation (N = 4). The procedure of flap formation with skin island in the rectangular form was successful, without complications. Much poorer results were achieved with the parasternal skin island formation. The failure rate of the reconstructive surgical procedure was 11.1% (N = 1), using Ryan operative method. Best result were achieved by flap tubulous in situ formation and rectangular skin island creation on the distal part of the muscle.

Antibiotic prophylaxis in clean-contaminated head and neck oncological surgery

BACKGROUND

Perioperative antibiotic prophylaxis has significantly reduced wound infection rates in clean-contaminated head and neck surgical procedures but controversy still remains regarding the optimal antibiotic regime.

OBJECTIVE

To examine the efficacy of different antibiotics in head and neck oncological surgery prophylaxis.

PATIENTS AND METHODS

In this prospective, double-blind clinical trial, 189 patients with carcinoma of the upper aerodigestive tract were randomized to receive amoxicillin-clavulanate or cefazolin intravenously up to 1h before surgery and at 8-h intervals for an additional three doses.

RESULTS

An overall wound infection rate of 22% was observed. The infection rate in patients receiving cefazolin was 24% (22/92) vs. 21% (20/97) in those receiving amoxicillin-clavulanate; the difference was not statistically significant. Postoperative overall non-wound infection developed in 12% (22/189) patients; the rate of infection was 9.8% (9/92) in patients receiving cefazolin vs. 13.4% (13/97) in those receiving amoxicillin-clavulanate, without a statistically significant difference between the two groups. Gram-negative bacteria were more often isolated with Pseudomonas aeruginosa as the dominant species. The risk of postoperative infection was more influenced by the type of surgical procedure than by disease stage.

CONCLUSION

In clean-contaminated head and neck oncologic surgery amoxicillin-clavulanate prophylaxis was at least as efficient as cefazolin. However, when taking into account the fact that beta-lactamase containing strains have recently been spreading, amoxicillin-clavulanate should be the logical first choice.

[Lethal midline granuloma]

Lethal midline granuloma is a rare clinical syndrome. In clinical practice the destructive process of the facial midline may appear as a symptom of various infective, malignant or autoimmune diseases. A physician must have a good knowledge of the problem in order to make a rational approach to diagnosis. The present paper discusses the case of a 34-year old patient with destructive changes of midline, nose, perforating of palatal cleft and destruction of bone structure of nose, maxillary and ethmoid sinus. For histopathologic diagnosis of T-lymphoma it was necessary to make immunohistological study of the biopsy specimen. Irradiation therapy with total dose of 5600 cGy showed an extremely good therapeutic result. Three years after irradiation therapy the patient is still in a remission.

[Hypersensitivity to pollen of Olea europea in patients with pollen allergy in the area of Zadar and Dubrovnik]

Olive pollen is one of the most important causes of inhalant allergy in countries around the Mediterranean sea. Due to the lack of information on hypersensitivity to the pollen of Olea europea from Croatian coast, the aim of this investigation was to establish the frequency of hypersensitivity to the pollen of Olea europea in pollen allergic patients in Zadar and Dubrovnik. Also, we compared two areas of Dalmatia regarding the number of patients and expression of allergy to the Olea europea. A total of 810 patients, children and adults, with pollen allergy were examined in both areas, Zadar and Dubrovnik. In the area of Zadar we examined 546 participants and in the area of Dubrovnik 264 participants. The patients were assessed by anamnestic data, clinical examination, measurement of pulmonary function (adults and children older than 7 years), skin prick test and enzymo-immunologic UniCAP test for measurements of specific IgE antibodies. For statistical analysis we used chi square test. Hypersensitivity to the allergy of Olea europea occurred in 66/810 (8.15%) assessed participants with pollen allergy. The comparison between the two areas didn't show any statistical difference in the number of affected participants with hypersensitivity to the Olea europea. Also, we didn't show any statistical difference in comparison of skin prick tests, immunologic measurements of specific IgE antibodies, or clinical manifestations between participants in the two investigated areas. The most prevalent clinical manifestation was rhinitis registered in 39/66 (59%) patients with hypersensitivity to the olive pollen. The majority of patients with hypersensitivity to olive pollen 51/66 (77%) live in towns. Only 3/66 (4%) participants live on an island. Rhinitis was the most prevalent clinical manifestation in our patients with hypersensitivity to allergen of Olea europea. Hypersensitivity to olive pollen was higher in participants who lived in towns. The hypersensitivity to Olea europea didn't show any difference between the two investigated areas of Dalmatia.

[Reconstruction of nasal tip in combined technique of cartilage disc grafts and onlay graft]

Rhinoplasty is often thought of as the most challenging of all aesthetic procedures. Irregularities of nasal tip implicate decreasing of nasal function and are generally regarded as an unattractive facial feature. The combined operative techniques which required extracorporeal septoplasty, incorporation of cartilage disc graft and onlay graft were performed in nineteen patients. Among the nineteen patients, fifteen had procedure of primary rhinoplasty and in four of them secondary or revised rhinoplasty was made. Indications for this operative technique were in patients with boxy nasal tip, bifid nasal tip, lateral alar tethering with extremely fat or thin nose skin. We emphasize that this technique is very successful with an acceptable percentage of postoperative complications. The tecnique is method of choice for reconstruction of extreme nasal tip irregularities where the usual reconstruction technique does not give satisfactory results.

Cervical necrotizing fasciitis: sources and outcomes

BACKGROUND

Abscesses of the peritonsillar region are among the most common deep abscesses of the head and neck. However, cervical necrotizing fasciitis (CNF) associated with a peritonsillar abscess is an extremely rare condition, with only 12 well-documented cases described.

PATIENTS

We reviewed and compared all 12 cases of CNF arising from peritonsillar abscesses, including our own case. CNF that developed after peritonsillar abscesses was also compared with that developing predominantly after odontogenic infection.

RESULTS

The overall mortality was higher in the group with peritonsillar abscesses (33% vs 25%).

CONCLUSION

It is probable that of all cases of CNF, that arising from peritonsillar abscess has the worst prognosis.

Necrotizing fasciitis after peritonsillar abscess in an immunocompetent patient

Cervical necrotizing fasciitis (CNF) is a rapidly progressive, severe bacterial infection of the fascial planes of the head and neck. Group A beta haemolytic Streptococcus spp. (GABHS), Staphylococcus spp., or obligatory anaerobic bacteria are the most common causative pathogens. The disease usually results from a dental source or facial trauma. Extensive fascial necrosis and severe systemic toxicity are common manifestations of CNF. Review of the literature reveals only seven such cases, with four successful outcomes. The authors present the case of a 50-year-old immunocompetent female with CNF arising from a peritonsillar abscess. Intravenous immunoglobulins in conjunction with surgery and antibiotics were used successfully. The authors also suggest the importance of the early diagnosis, aggressive surgical debridement, broad-spectrum antibiotics, and possible usefulness of the intravenous immunoglobulins in the treatment of CNF, especially when the disease is associated with toxic shock syndrome.

[Post-streptococcal reactive arthritis: diagnostic problems]

The authors present clinical, microbiological and scintigraphic findings in eight children with poststreptococcal reactive arthritis, hospitalized in the Zadar General Hospital from 1990 to 1992. In all patients an antecedent throat infection was noticed, 7-10 days before the first symptoms and signs of arthritis developed. Antistreptolysin O microtitration and/or throat culture revealed streptococcal infection in all patients. Scintigraphic examination with Te-99m yielded four positive (50%) results. In the follow-up one of the positive scans was later suggestive of tumorous process. The authors conclude that accurate diagnosis of poststreptococcal reactive arthritis depends on microbiological identification of streptococcal infection and longitudinal clinical follow-up in which scintigraphy may be of differential diagnostic benefit.