DOES AUDIOVESTIBULAR POST-COVID SYNDROME EXIST?

The purpose of this study was to present and analyze patients with audiovestibular post COVID-19 syndrome, and highlight the most characteristic and most common findings. We analyzed 87 patients aged between 20 and 86 years who presented to the Audiology Division between February 1, 2021 and July 1, 2021 after having been isolated due to the SARS-CoV-2 infection. Study patients presented with complaints of persistent hearing loss, tinnitus, and vertigo, lasting for more than 3 months. Study results showed that there was acute sensorineural hearing loss in 4 patients during the SARS-CoV-2 infection. None of the patients experienced complete hearing recovery after 3 months. High frequency hearing loss (at 4 kHz and 6 kHz) occurred bilaterally, and was found in 52 patients. This finding of gradual hearing loss was both the most characteristic and most common in COVID patients. Extensive damage can directly occur to inner ear structures, including hair cells, the Corti organ, and the cochlear nerve because of this viral infection. A total of 73 patients had tinnitus. 68 patients had unilateral tinnitus, and only 5 patients had bilateral tinnitus. Exacerbation of tinnitus was recorded in 12 patients and new-onset tinnitus in 61 patients. Vertigo occurred in 9 patients, all of which were new-onset. A conclusion of our research is that audiovestibular post-COVID syndrome does exist. Further research with more patients and over a longer period is needed to obtain a better and longer effect on the audiovestibular system and audiovestibular complications, as well as an insight into possible recovery.

Surgical Treatment of Recurrent Metastatic Parathyroid Gland Carcinoma

Aim

We present the case of a 48-year-old male patient who underwent surgery for a recurrent metastatic parathyroid gland carcinoma in the patient’s right paratracheal space of the neck. The patient had undergone surgery for lower right parathyroid gland carcinoma 28 months earlier.

Results

The metastases were resected en bloc with an ipsilateral central neck dissection and with the removal of the enlarged lower left parathyroid gland. After exploration of the remnant parathyroid glands we noticed that lower left parathyroid gland was macroscopically enlarged so we decided to remove it to prevent possible hypercalcemia in future and to also prevent possible recurrence of cancer or development of a new primary, considering the identical embryological origin of the lower parathyroid glands and possibility of synchronous, multiple tumors, which generally follow the same embryological origin if they occur. The patient was also treated with radiation therapy after the surgery.

Conclusion

With the present surgical approach to recurrent metastatic parathyroid gland carcinoma, we aimed to prevent the recurrence of cancer or development of new primary and prevent or delay hypercalcemia in the future with all severe adverse metabolic states associated with high serum calcium levels.

Treatment Approach to Follicular Thyroid Carcinoma Tumor Thrombus in the Internal Jugular Vein and Brachiocephalic Vein

Thyroid gland carcinoma causing tumor thrombus in the great veins of the neck and mediastinum is a rare condition with poor prognosis. Invasion of the internal jugular vein by thyroid gland carcinoma has been occasionally reported, but tumor thrombi extending to the great veins of the mediastinum are reported extremely rarely. We present a treatment approach in a case of follicular thyroid carcinoma intravascular tumor thrombus in the left internal jugular and left brachiocephalic vein.

Albrecht von Graefe (1828-1870) and his contributions to the development of ophthalmology

PURPOSE

The aim of this article is to show Albrecht von Graefe's contributions to the development of ophthalmology on the occasion of the 150th anniversary of his death. He is regarded as the greatest ophthalmologist of the 19th century. Modern and scientific ophthalmology owes its beginning to him.

METHODS

Extensive literature research is made and contacts with institutions for history of medicine as well as medico-historians in the field of ophthalmology.

RESULTS

His contributions to ophthalmology were multiple. Von Graefe was the first to introduce iridectomy in acute glaucoma treatment, initiated visual field testing and developed the first tonometer. He made the first classification of glaucoma. Von Graefe was the ophthalmologist who created a special knife for cataract surgery. He was also the first to use Helmholtz' ophthalmoscope. He founded the first ophthalmological society in the world and the second ophthalmology journal which has been published continously up to now. In 1852 he founded famous private eye clinic in Berlin, where he treated many eye patients and educated many prominent ophthalmologists. At the age of 29 he became associate professor of ophthalmology, the first with such a title in Germany.

CONCLUSION

Albrecht von Graefe was founder of modern ophthalmology and separated it from surgery. Graefe's contacts, correspondency and meetings at ophthalmological congresses with his teachers, assistants, collegaues also contributed to international co-operation and internationalization in ophthalmology. Although Albrecht von Graefe died before 150 years, he still provokes great admiration and respect in the world of ophthalmology.

PENETRATING ORBITOCRANIAL INJURY

- A case of a 37-year-old female patient is presented. The patient was admitted to the Surgical Emergency Unit after accidental fall on a metal rod when she had sustained stab injury of the right orbit with penetration into the right frontal brain lobe. Multi-slice computed tomography (MSCT) showed penetrating injury and fracture of the right orbital roof without eyeball damage and endocranial impressed bone fragments into the right frontal brain lobe. Urgent surgical intervention was performed by a maxillofacial surgeon and neurosurgeon, including reposition of bone fragments of the orbital roof and cranioplasty. Reconstruction of Tenon's capsule of the right eyeball was performed by an ophthalmologist. From the intraoperative wound swab of the orbit, Bacillus cereus was isolated, therefore the patient was administered ciprofloxacin and rifampicin as recommended by an infectious disease (ID) specialist. Follow up brain MSCT at 15 days and magnetic resonance imaging of the brain at 25 days showed brain edema in the right frontal area and signs of local brain abscess. Intravenous administration of the ciprofloxacin and metronidazole antibiotics with corticosteroids for edema suppression were ordered by the ID physician. Fourteen weeks after this therapy, brain MSCT showed complete abscess regression and no neurologic deficit with only mild psychomotor changes.

Formula for the prediction of apnea / hypopnea index in children with obstructive sleep apnea without polysomnography according to the clinical parameters: Is it reliable?

PURPOSE OF THE STUDY

The aim of the study was to propose "the risk formula" for obstructive sleep apnea in children according to the general and local clinical parameters and findings relevant for obstructive sleep apnea (OSA) severity. The unmet need for this formula arises from the economic burden of polysomnography (device, staff, training, special sleep centers, etc) as the golden standard for the diagnostics.

MATERIALS AND METHODS USED

The study was performed from January 2013 until January 2016 in the Sleep Center, Department for Neuroscience, School of Medicine of the University of Split, Department of Pediatrics, University Hospital Split, Croatia and ENT Dept. University Hospital in Split, Croatia. Inclusion criteria were: age > two years, AHI >1 diagnosed by polysomnography. Exclusion criteria were: chronic lung disease, active tonsillitis/pharyngitis at the time of the physical exam and syndromes that affect breathing. All polysomnograms were scored by a qualified sleep technologist and interpreted by two board certified sleep physicians independently. Age, sex, BMI, Mallampati score, tonsillar size and adenoids size were recorded. All statistical calculations were performed using SPSS 20.

RESULTS

In total 60 children were included in the study. The median of age was 5 years (range 2-9). There were 19 (32%) girls and 41 (68%) boys. Of all evaluated predictors, there were statistically significant differences in the values of AHI among children with different modified Mallampati score (χ2 = 28.2; p < 0.001), different size of tonsils (χ2 = 25.3; p < 0.001) and different size of adenoids (z = 2.7; p = 0,006) in univariate regression analysis. Strong positive association of AHI with modified Mallampati score (standardized B = 0.51; partial correlation = 0.542, r = 0.631) was found, as well as positive correlation of AHI with tonsillar size (standardized B = 0.246; partial correlation = 0.295,R = 0.489) in the multivariate forward stepwise regression analysis.

CONCLUSION

Even though we are aware that PSG is the gold standard for diagnostics of SDB there is a significant financial burden for this diagnostic procedure. That is why there is a necessity for establishing good clinical standards and possible formula for OSA severity evaluation. We propose formula which includes Mallampati score and tonsillar size for OSA -risk calculation in order to perform early therapeutic intervention thereby reducing the risk of long-term negative consequences. We recommend this formula as the screening formula in circumstances where PSG is not available, in cases when the "waiting list" is too long or when a child can not cooperate to perform it. In developing countries like Croatia on time intervention with reduced procedure-associated costs is of the utmost importance.

A Foreign Body (Toothbrush) in the Esophagus of a Patient with Hiatal Hernia

Toothbrush ingestion is rare and most commonly seen in patients with psychiatric comorbidities and in young women with a medical history of eating disorders who try to induce emesis. Long ingested objects, such as a toothbrush, cannot pass the gastrointestinal tract spontaneously and require endoscopic removal or even a surgical approach in cases of unsuccessful endoscopic removal or complication development. We present a case of a 71-year-old male with hiatal hernia without psychiatric or neurological comorbidity who accidentally ingested a toothbrush during oral hygiene routine. After X-ray confirmation, the toothbrush was removed endoscopically.

[Anaplastic Thyroid Carcinoma in a 17-Year-Old Female Patient]

Anaplastic carcinoma of thyroid gland is one of the four most malignant tumors in humans. It appears in one or two patients per million per year. It is very rare in children. A 17-year-old female patient was admitted to the Clinical Department of ENT and Head and Neck Surgery, Split University Hospital Center, for thyroid gland surgery due to rapid growth of a node in the thyroid gland left lobe. Preoperative examination indicated benign nature of changes. Total thyroidectomy with levels VI and VII neck dissection was done. Intraoperative slide of the left lobe was malignant. Positron emission tomography and computed tomography were also done. The finding was negative. The patient was examined by an ENT-oncology team and juvenile radiotherapy was administered. It was found to be carcinoma stage IVa according to TNM classification. One year after the operation, the patient was well and had no signs of illness. This case report is a contribution to the existing but scarce knowledge of anaplastic carcinoma of thyroid gland in young patients in the world.

[DR ALEKSANDAR DORŠNER THE FIRST HOSPITAL OTORHINOLARYNGOLOGIST IN SPLIT AND DALMATIA]

Dr Aleksandar Doršner (Trebinje, 1892 - Lima, 1967) was the first hospital otorhinolaryngologist in Split and Dalmatia. He graduated from the Faculty of Medicine in Prague in 1919, and specialized otorhinolaryngology in Graz and Vienna. He led and organized otorhinolaryngological service in Split Hospital from 1923 to 1934, and he also had a private practice. Temporarily he also worked outside Split in Dalmatian hinterland and in Šibenik, Zadar and Dubrovnik. Most frequently he performed the following otorhinolaryngological operations: tonsillectomies and adenoidectomies and operations of purulent middle ear inflammations with mastoiditis, nasal polyps, deviated nasal septum, maxillary sinus empyema and otorhinolaryngological trauma. In 1928 he became a member of Otorhinolaryngological section of Croatian Medical Chamber. He participated in the work of the first otorhinolaryngological congress of the former Yugoslavia in 1931, taken place in Zagreb. From 1928 he was a member of Oto-Neuro-Ophthalmological Society. From 1933 to 1937 he was a vice-president of the main board of Free Organization of Dalmatian Physicians in Split. In 1938 he left Split permanently and continued living with his family in Lima (Peru) where he died in 1967. He was an erudite. He lived for his profession which he liked very much and dedicated his life to. He is one of the most meritorious doctors in Split medical history, whom otorhinolaryngology service in Split Hospital started with.

The influence of retinal eye diseases on painting

In this work the possible influences of some retinal eye problems on paintings of several famous artists are considered. The change of painting styles and artistic expression in different periods and ages in a group of world-wide well-known painters are described and correlated with known or suspected retinal diseases. Some of them largely became recognizable because of that. Contemplations are offered about the effects of retinal diseases in the works of Degas, Munch, Cézanne, O'Keeffe, Constable and Goya. Retinal eye diseases have a significant impact on the work of selected famous painters.