Biomedical subjects

D Dankuc

Publications and source records attributed to D Dankuc.

5 recordsLinked to original sources

PubMedDate not supplied

[Mycotic disease of the mucous membranes of the head and neck].

INTRODUCTION: Candidiasis is usually a superficial infection of the moist areas of the body and is generally caused by Candida albicans. Visceral infections occur in diabetes, lymphomas and leukemias, malnutrition, avitaminosis and they are associated with antibiotic, corticosteroid and immunosuppressive therapy. Candida albicans was isolated from middle ear inflammation. The diagnosis is made on the basis of microscopic appearance of colonies and characteristic smell. Candidiasis is successfully treated with nystatin, imidazol derivatives (fluconazole, ketoconazole and intraconazole), amphotericin B, 5-fluorocystosine and 1% iodine solution. CASE DESCRIPTION: This is a case report of a 46-year-old patient with a persistent nasal, sinus and ear infection of unknown origin. The patient first received antibiotic and steroid therapy and trepanation of the right maxillary sinus was performed. As the patient's condition aggravated with increase of temperature and bad laboratory findings, he was hospitalized. Radiography revealed a pathological process in both maxillary sinuses and both mastoids, so mastoidectomy and left maxillary sinus trepanation were performed. Histopathological examination of the right mastoid revealed a mould infection. The immunologic status pointed to hypogammaglobulinemia IgG. The following diseases were excluded: systemic diseases, blood diseases, Reiter's syndrome, AIDS, Hepatitis B, other viral diseases, toxoplasmosis, trichinellosis, borreliosis, typhus, paratyphus and exanthematous typhus. The diagnosis of candidiasis caused by Candida crusei and Candida kefyr was made on the basis of macroscopic and microscopic findings and biochemical identification. Ketoconazole was introduced (400 mg/per day) as well as high doses of vitamins and povidone-iodine locally. After a period of remission the patient died due to myocarditis, sepsis, acute kidney failure associated with severe mucosal necrosis of the mouth, esophagus and throat. Differential diagnosis in fever of unknown origin must include the possibility of mycotic infection, whereas the therapy of mycotic diseases must include two antimycotics at the same time. DISCUSSION AND CONCLUSION: Candida albicans is often found in the oral cavity and skin as well as in intestines of 18% of healthy subjects. It is unknown why it causes clinical illness. Antibiotic therapy of bacterial infections enables candida colonization especially in immunosuppressed patients. In our patient two types were found: Candida krusei and Candida kefyr. It is of special importance to perform differential diagnosis in cases with fever of unknown origin in order to include the possibility of mycotic infections, whereas treatment of systemic fungal infections requires a team of physicians.

Candidiasis↗

PubMedDate not supplied

[Otogenic herpes zoster--the Ramsay-Hunt syndrome].

INTRODUCTION: Herpes zoster is a viral disease caused by a specific neurotropic virus-varicella zoster, similar to varicella virus, but not identical. Herpes zoster oticus was described by Letulle in 1882 and Körner in 1884, but particularly studied by Ramsay Hunt who reported it as a herpetic disease of ganglion geniculi in 1907. Herpes zoster oticus associated with facial nerve paralysis is most commonly called the Ramsay-Hunt syndrome. MATERIAL AND METHODS: In this work, cases of herpes zoster oticus associated with facial nerve paralysis are shown. At the ORL Clinic in Novi Sad, in the period from 1996-1997, 5 cases with Ramsay-Hunt syndrome were treated. The diagnostic procedure involved analysis of anamnestic data, clinical examination, complete cochleovestibular investigation with electronystagmography (ENG), topodiagnostic investigation of facial nerve (Schirmer's test, stapedial reflex, electrogustometry), electromyographic investigation (EMG), laboratory and virusologic investigations. According to many statistical data, paralysis of facial nerve due to herpes zoster is after Bell's paralysis the most common cause of the disease. The efflorescence of auricula, face and neck, which are typical manifestations of the disease, may precede facial nerve paralysis for about a week or more, and therefore may be disregarded and misdiagnosed with Bell's paralysis. The peripheral paralysis of this nerve in herpes zoster has an unfavorable course. More than 75% of patients have consequences of paralysis (paresis, hemispasm, synkinesia etc.). Regarding the unfavorable recovery period in herpes zoster, we managed our patients accordingly. CONCLUSION: Herpes zoster oticus is a common cause of peripheral facial nerve paralysis. The clinical course is not as favorable as in Bell's paralysis. It may be associated with sensorineural hearing disorder, vertigo and paralysis of other cranial nerves. The therapeutic procedures in Ramsay-Hunt syndrome include administration of conservative therapy and surgical intervention. We performed surgery in 2 and conservative therapy in 3 patients. Facial nerve decompression is indicated in persistent paralyses, or in cases without clear clinical signs of recovery after 6 weeks-2 months from the onset of the disease. The site of decompression is determined by topodiagnostic investigations.

Female↗

PubMedDate not supplied

[Simultaneous extracranial and intracranial otogenic complications].

INTRODUCTION: Chronic otitis media is the most common cause of otologic complications. A simultaneous occurrence of extracranial and intracranial otologic complications is rare in clinical practice. In this paper, we are presenting a patient with exacerbation of chronic otitis media and associated otologic complications: peripheral facial nerve palsy and subdural cerebral abscess. CASE REPORT: A patient aged 56 who has suffered from chronic otitis media during the past 37 years, was admitted at the Clinic of Otorhinolaryngology due to worsening of the underlying disease. The clinical examination revealed chronic otitis media with granulation in the external auditory canal, pulsatile discharge and extracranial otologic complication--facial nerve paralysis. The preoperative diagnostic procedure included: cochleovestibular investigations (hearing disorder of mixed type on the left side with normal labyrinthine function), temporal bone radiography (sclerotic cell alteration of mastoid on the left), topodiagnosis of facial nerve). The laboratory finding confirmed increased number of leukocytes (21.7 x 10(9)/l), increased erythrocyte sedimentation rate (25/58 mm/h), increased fibrinogen (5.0 g/l) and presence of protein in urine. Chest and heart X-ray findings were normal. Staphylococcus aureus was isolated from ear discharge by microbiological investigation. Signs of meningitis were negative, the liquor was colorless, slightly stirred up with total number of cells 384 x 10(6)/l, sugar 2.7 mmol/l and total proteins from 0.82 g/l. Bacteriological liquor culture was negative. The ophthalmologic examination confirmed normal finding of the eye fundus and absence of increased cranial pressure. For further diagnostics CT (computerized tomography) and MRI of head (magnetic resonance imaging) were performed. The findings confirmed subdural abscess and suspected encephalitic foci of the left cerebral lobe. According to findings, surgery involving radical trepanation of the temporal bone, decompression of facial nerve, denudation of sigmoid sinus dural sinus and angle area and incision of dura mater of the cranial fossa posterior with drainage of subdural abscess (meningitis surgery) was performed. CONCLUSION: A simultaneous occurrence of extracranial and intracranial otologic complications accompanied by subdural abscess is rare in clinical practice. The mechanism of development and spreading of subdural abscess is very interesting. In this case, subdural abscess caused the reaction of dura mater, which has prevented spreading of the disease by cerebrospinal liquid at the onset. However, there is a possibility of its further spreading by blood vessels into the brain white substance, where encephalitic foci may develop and later brain tissue abscesses as well. The clinical course of subdural abscess may be atypical, without headache and increased cranial pressure. This kind of disease demands a complex diagnostic procedure, sufficient otosurgical and neurosurgical interventions, cooperation with infectologist and administration of antibiotic therapy.

Brain Abscess↗

PubMedDate not supplied

[Congenital fistula of the stapedial footplate as an avenue for recurrent purulent meningitis].

INTRODUCTION: Congenital fistula of the stapedial footplate is a rare cause of recurrent purulent meningitis and a diagnostic and therapeutic problem as well. CASE REPORT: We report a case of a stapedial fistula diagnosed intraoperatively in a 4-year-old boy, after recurrent meningitis. The boy was hospitalized at the Pediatric Clinic three times in a 6-month period because of recurrent meningitis. The applied anti-meningitis therapy presented with good general state of the child, but the main target was to discover the cause of recurrent meningitis. Immunologic and genetic investigations were performed. Otorhinolaryngologic findings nearly normal, except minimal asymmetry in the otoscopic finding. Eardrum was reddish with all other characteristics of a normal drum. The tympanometric curve was of type B/C on the right ear. MRI revealed hydrocephalus internus with signs of inflammation of mastoid cells and cavum tympani indicating explorative myringotomy and antrotomy. Intraoperatively, we found cerebrospinal fluid in the antrotympanic cavity, including malformation of the incus without contact with stapes and fistula on the middle part of the stapedial footplate with flow out of the perilymph. CONCLUSION: Perilymphatic fistula is a rare cause of recurrent meningitis, whereas congenital ear malformation may be a cause of recurrent meningitis, particularly in children. The diagnosis is intraoperative. The surgical treatment may be very difficult, often requiring revision of procedures especially if cerebrospinal fluid pressure is increased.

Child, Preschool↗

PubMedDate not supplied

[Otoacoustic emissions--a step closer to understanding cochlear function].

INTRODUCTION: Otoacoustic emission is a phenomenon that may occur in a large group of normal-hearing subjects. Ear is an organ which collects and treats sounds from the surrounding environment, and nerve fibres transmit the perceived information to the brain in terms of nerve signals. However, ear can also produce a sound (otoacoustic-emission), which can be recorded using very sensitive microphones placed in the ear canal. OTOACOUSTIC EMISSION: Otoacoustic emissions may be spontaneous (SOAE) or may be a response to given auditory stimuli: transiently evoked otoacoustic emissions (TEOAE) and distortion product otoacoustic emissions (DPOAE). Applications of otoacoustic emissions in clinical and experimental medicine are various. Hearing screening program of newborns aims to identify infants with permanent bilateral hearing loss in the first days after birth. Screening programs are based on recordings of transiently evoked otoacoustic emissions (TEOAE) in the first step, and then (if it is necessary) brainstem evoked response audiometry. Transiently evoked otoacoustic emissions may also be used for differential diagnosis of cochlear and retrocochlear disorder. UTILIZATION: In cases of substantial retrocochlear pathological findings without cochlear involvement, transiently evoked otoacoustic emissions should be recordable because outer hair cell function is unaffected. It is possible to detect ototoxic effects of drugs before hearing loss can be detected by other methods (pure-tone audiometry). In a similar way, using otoacoustic emissions, it is possible to detect noise induced damages of the outer hair cells. Otoacoustic emissions provide a unique means for assessing the integrity of the medial efferent pathway. Further research into the properties of various types of otoacoustic emissions would contribute to understanding of cochlear function, and in particular, the relative roles of inner and outer hair cells. Evoked otoacoustic emissions are directly related to outer hair cell function and may be somewhat independent of inner hair cells. At present, there is insufficient evidence to indicate whether inner and outer hair cell disorders can exist separately, and if they can, whether they are so strongly correlated that statistically the distinction is meaningless. Applications of otoacoustic emissions in clinical practice is an important route in furthering our understanding.

Cochlea↗