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Biomedical subjects

E Ferekidis

Publications and source records attributed to E Ferekidis.

33 records · Page 2Linked to original sources

Intrasphenoidal encephalocele and spontaneous CSF rhinorrhoea.

Intrasphenoidal encephalocele is a rare clinical entity. In the international literature only 16 cases have been reported up today, with female predominance. Clinically they manifest at middle and advanced ages (40-67 years), when spontaneous CSF rhinorrhoea or recurrent meningitis occurs. We present our case, a 46 years old female, who had CSF rhinorrhoea from the right vestibule for 10 months. The diagnosis was based on the history and the high-resolution brain and skull base CT-scanning in conjunction with opaque fluid injection in the subarachnoidal space through a lumbar puncture. She was successfully treated with an operation, through an endonasal trans-ethmoid microendoscopic approach, using the Draf and Stammberger technique. We discuss the pathogenesis of the intrasphenoidal encephalocele, the existence of small occult defects in the skull base, which cause, at the middle and advanced ages, CSF fistula with spontaneous CSF rhinorrhoea and/or recurrent meningitis. Finally we emphasize the advantages of the endonasal surgical approach for the treatment of this condition.

Cerebrospinal Fluid Rhinorrhea↗

Supraglottic laryngectomy--series report and analysis of results.

Between October 1987 and October 1993, 92 patients with squamous cell carcinoma of the supraglottis were treated by supraglottic laryngectomy and neck dissection in our department. There were 33 T1, 46 T2, six T3 and seven T4 cases. All patients with N+ necks and T3 or T4 tumours received post-operative radiotherapy (5,000-6,500 cGy). The patients were followed for a minimum of 36 months or until death. The incidence of local recurrence was 7.6 per cent. Neck recurrence was observed in 13 per cent of patients. Decannulation was achieved in 93.4 per cent of the cases with three patients undergoing gastrostomy because of aspiration. The average hospital stay was 26 days. The overall three-year survival was 83.6 per cent, with eight patients dying of unrelated causes. There was a significant difference in recurrence rate between patients in the N0 and the N+ stage.

Aged↗

Isolated sphenoid sinus aspergillomas.

Fungi are more often than previously believed to be the causative organisms of paranasal sinusitis. Aspergillus, a fungus belonging to the Ascomycetes class, accounts for the majority of these infections, which affect not only debilitated patients but healthy people as well. There are two distinct clinical forms of Aspergillus sinusitis, invasive and non-invasive, and each of them is further divided in two subtypes. Isolated aspergillosis of the sphenoid sinus is a rare disease, which is usually misdiagnosed for a long time because of its varying symptomatology. In the present study, four cases of isolated sphenoid Aspergillus disease are described and the recent literature is reviewed. Physicians should be aware of this rare clinical entity, as in many cases early diagnosis and appropriate treatment provide the key to achieve favourable outcomes.

Adult↗

Modifications of the Caldwell-Luc procedure for the prevention of post-operative sensitivity disorders.

The effectiveness of some modifications of the Caldwell-Luc standard procedure in the prevention of post-operative mid-facial sensitivity disorders was investigated in a prospective comparative study at the ENT Department, Faculty of Medicine, University of Athens, Greece, from 1986-1992. Sixty-nine maxillary sinuses were operated on in 61 patients suffering from benign pathological conditions. The modifications concerned the type of mucoperiosteal incision and the site and size of the created anterior antrostomy. Only 8.7 per cent of the sinuses operated on by the modified technique presented with post-operative disorders whereas among those operated on by the classical technique, the ratio climbed to 33 per cent. In view of the findings of this study, the modifications applied can be valuable in treating non-extensive maxillary sinus disease with minimal post-operative sensitivity disorders.

Adult↗

Alterations to the oropharyngeal and nasopharyngeal microbial flora of children after tonsillectomy and adenoidectomy.

The oropharyngeal and nasopharyngeal microbial flora of 40 children with chronically hypertrophied and infected tonsils or adenoids, was studied. Twenty of the children were treated by tonsillectomy and 20 by adenoidectomy. Swabs were taken from the surgical field pre-operatively and from the oropharynx or the nasopharynx 10 and 30 days-post-operatively. The swabs were cultured on suitable culture media and identification as well as quantitative estimation of the isolated bacteria, was carried out. Most of the potentially pathogenic bacteria exhibited beta-lactamase production. Interestingly, after surgical treatment, the respective microorganisms were quantitatively reduced and it was observed that their isolation rate was also lower. Furthermore, bacteria considered as normal inhabitants regularly showed an increase in their frequency of isolation despite the fact that a quantitative decrease was in some instances observed. These findings suggest that tonsillectomy and adenoidectomy result in an alteration to the abnormal oropharyngeal and nasopharyngeal microbial flora producing an almost normal one. It appears that, in cases of the failure of antimicrobial treatment, surgical procedures should be seriously considered.

Adenoidectomy↗

[Reconstruction of large defects of the auricular and parotid area (author's transl)].

The use of a local flap for a reconstruction of very large defects of the auricular and parotid area is described. This flap combines the advantage of a local and a regional flap, it is safe in use, easy to design, it permits a simultaneous radical neck dissection to be performed, it does not leave a secondary defect and it is convenient for the patient.

Ear, External↗

[Hearing loss and hyperthyroidism (author's transl)].

The audiometric findings on 23 patients with diquited hypothyroidism for a minimum of 4 months to a maximum of 20 years are presented. Audiometric tests, including acustic impedance measurements (tympanometry, stapedius reflex) were performed on all patients before and after an adequate substitution therapy. In 12 patients there was a definite impairment of hearing before the substitution therapy. Eight of them have shown a mild to moderate sensory-neural deafness. Four showed a mixed deafness, in three of which a negative pressure of 300 mm H2O was measured in the middle ear, the fourth one had a seromucotympanon. In three patients with pure sensory-neural deafness the stapedius reflex was elicitated only 30 dB over the pure tone threshold in speech frequencies. The audiometric measurements after an adequate substitution therapy of minimum 4 months has shown a definite improvement of hearing loss.

Acoustic Impedance Tests↗

Prognostic value of multiple-frequency tympanometry in acute otitis media.

Multiple-frequency tympanometry (MFT) and conventional 226-Hz tympanometry were performed in 86 ears of children affected by acute otitis media (AOM) after therapy. In a 3-month follow-up period, the recurrence rate of AOM and persistence of middle-ear effusion in these children were evaluated in comparison with the early results of the two methods, as well as the relation of MFT findings to the possibility of development of AOM sequelae. It seems that abnormal resonant frequency values and recordings by MFT right after an episode of AOM indicate persistence of changes in the mass and stiffness balance of the middle ear, not demonstrated by conventional tympanometry, that could be responsible for a higher probability of AOM sequelae.

Acoustic Impedance Tests↗

Pituitary apoplexy: a pathologic entity from an otolaryngologist's view.

A case of pituitary apoplexy, which was initially misdiagnosed as 'acute frontal sinusitis', is reported. The presenting symptoms and signs of the patient were headache, moderate fever, left periorbital edema, marked tenderness over the left frontal sinus and purulent secretion over the left middle turbinate and nasopharynx. These clinical symptoms were wrongly perceived as complicated frontal sinusitis. The CT scan and the elective right carotid angiography showed a pituitary adenoma. Therefore pituitary apoplexy of a preexisting pituitary adenoma was diagnosed. The patient underwent surgical removal of the adenoma and his postoperative course was uneventful. Thus otolaryngologists should consider pituitary apoplexy in the differential diagnosis of pathologies concerning the anatomic area of the anterior cranial fossa.

Adult↗

Burkitt's lymphoma in the base of the tongue: differential diagnosis and management.

Burkitt's lymphoma is the most common malignancy in African children but can occur sporadically in every country. It is one of the most aggressive malignancies in the human body, and in the past the prognosis was very poor. However, complex chemotherapy regimens can now cure approximately 50-80% of adult patients with Burkitt's lymphoma or small noncleaved lymphoma, and in pediatric populations the cure rate is even higher. Although the African type has a preference to the head and neck region (whereas the sporadic type to the abdomen), involvement of the base of the tongue is extremely rare as only 1 case has ever been reported in the English literature. The present study describes a patient with Burkitt's lymphoma presenting as a single mass in the base of the tongue without any abdominal or other extra-abdominal involvement. The patient was submitted to chemotherapy (intravenous and intrathecal) and skull radiotherapy. Today, 17 months after the diagnosis, the patient is disease free. Physicians should be aware of the extranodal manifestations of Burkitt's lymphoma and their differential diagnosis in order to achieve early diagnosis and treatment.

Adult↗

Multiple-frequency tympanometry in children with otitis media with effusion.

Multifrequency tympanograms were recorded from 76 ears of 43 children affected by otitis media with effusion (OME) and 90 ears of normal-hearing children to obtain data for resonance frequency (RF) and changes in phase angle. There was found to be a statistically significant decrease (p < 0.01) in both RF values and change in phase angle in ears with OME compared to normative data. This decrease may be interpreted by considering OME as a mass pathology. Multiple-frequency tympanometry seems to be a useful method for determining the effect of various middle-ear pathologies on the mechano-acoustical status of the middle-ear system.

Acoustic Impedance Tests↗

Effect of the number of averaged responses in transient evoked otoacoustic emissions on the results of neonatal hearing screening.

This study examined the effect of the number of accepted responses in transient evoked otoacoustic emissions on the results of neonatal hearing screening programmes. The ILO88 Otodynamics Analyzer Quickscreen programme was used for all testing, and a three-stage procedure was adopted by averaging 20, 30, and 260 low-noise samples in total. The results were recorded after each stage of the testing in those cases in which, after the first 20 accepted responses, the "pass" criteria were met. Under these circumstances, 117 ears were included in the study from a total number of 334 screened ears. It was concluded that 20 averaged quiet responses are adequate for screened newborn babies to pass the test if the conditions of the "pass" criteria are fulfilled at this stage. In the rest of the newborn babies, testing should be continued using a larger number of clicks. For diagnostic and clinical purposes, the full 260 quiet samples must be used since the results indicated statistically better scores in response and reproducibility measures after the 260 averaged responses.

Cochlea↗