ABSTRACT
Background A Caesarean section (CS) if performed under general anesthesia (GA) is a procedure with an increased risk of accidental awareness. This study aimed to examine the incidence of accidental awareness under GA in hospitals in the Republic of Srpska (Bosnia and Herzegovina) where GA for CS is performed in a significantly higher percentage compared to spinal anesthesia. Methodology In the period from 2016 to 2018, a multicenter, prospective, observational study was conducted in five medical centers in the Republic of Srpska (Bosnia and Herzegovina). The study included 1,161 patients who underwent CS. A total of 427 (36.7%) patients had elective and 734 (63.3%) had emergency CSs. The patients were surveyed postoperatively using the modified Brice questionnaire. Results Of the 1,161 patients included in the study, 12 (1.03%) reported memory in the period between induction and emergence of anesthesia. Five (0.43%) of them reported definite and seven (0.6%) possible and unlikely awareness. Significant psychological trauma due to pain was reported by two patients. Dreams during anesthesia were reported by 42 patients (3.61%) and five of them stated that the dreams were unpleasant. Conclusions Accidental awareness under GA during CS has a significant incidence in medical centers in the Republic of Srpska (Bosnia and Herzegovina). According to our findings, creating new protocols for GA when performing CS is necessary.
ABSTRACT
INTRODUCTION: Primary mucosal melanoma of the sinonasal tract is a rare neoplasm, accounting for less than 1% of all melanomas. It has an aggressive and unpredictable biologic behavior characterized by frequent incidence of local recurrence, local and distant metastasis of the disease. CASE REPORT: This report summarizes the results of the previous research concerning sinonasal mucosal melanoma, and by the example of the two patients suffering from mucosal melanoma, we described clinical and histopathological features of this rare neoplasm and our experience in its diagnosis and treatment. CONCLUSION: Only histopathological analysis complemented by immunobistochemical analysis contributes to early and accurate diagnosis of the disease.
Subject(s)
Melanoma/pathology , Nasal Mucosa/pathology , Paranasal Sinus Neoplasms/pathology , Paranasal Sinuses/pathology , Aged , Aged, 80 and over , Antineoplastic Agents/therapeutic use , Biomarkers, Tumor/analysis , Biopsy , Female , Humans , Immunohistochemistry , Male , Melanoma/chemistry , Melanoma/therapy , Nasal Mucosa/chemistry , Nasal Mucosa/drug effects , Nasal Mucosa/surgery , Palliative Care , Paranasal Sinus Neoplasms/chemistry , Paranasal Sinus Neoplasms/therapy , Paranasal Sinuses/chemistry , Paranasal Sinuses/drug effects , Paranasal Sinuses/surgery , Radiotherapy, Adjuvant , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
INTRODUCTION: Angioedema is characterized by subcutaneous and/or submucosal swelling usually localized to the lips, eyelids, tongue, oral cavity, larynx and pharynx. Various types of angioedema, caused by different pathophysiologic mechanisms, can have the same or very similar clinical picture and require different diagnostic and therapeutic procedures. The immediate threat to life as a result of rapidly developed edema of the pharynx and larynx with airway obstruction requires endotracheal intubation or emergency tracheotomy. Standard therapy, which includes epinephrine, second-generation antihistamines and steroids, is not effective in the treatment of all types of angioedema. OBJECTIVE: On the basis of the clinical presentation and course of angioedema, this retrospective study was aimed at contributing to a better understanding of the etiopathogenesis of the disease and at helping determine the most effective available treatment modalities. METHODS: This retrospective study included patients treated under the diagnosis of angioedema of the upper aerodigestive tract between 2000 and 2012 in the Department of Otorhinolaryngology, Clinical Center of Banja Luka. RESULTS: A total of 76 subjects were included in the study. The average age was 62.8 years. There were 40 (52.6%) male and 36 (47.4%) female patients. The largest number of patients (44.7%) had type II angioedema. Almost half of the patients or 36 patients (47.4%) were on treatment with an angiotensin-converting enzyme inhibitor (ACEi), but there was no statistically significant difference under the total number of patients (p=0.678). CONCLUSION: Better understanding of pathophysiologic mechanisms and the adoption of diagnostic protocols contributes to more effective treatment of angioedema.
Subject(s)
Airway Obstruction/etiology , Angioedema/physiopathology , Angioedema/therapy , Angiotensin-Converting Enzyme Inhibitors/adverse effects , Aged , Airway Obstruction/therapy , Angioedema/etiology , Angiotensin-Converting Enzyme Inhibitors/administration & dosage , Female , Humans , Intubation, Intratracheal/statistics & numerical data , Male , Middle Aged , Respiratory System , Retrospective Studies , Risk Factors , SerbiaABSTRACT
Transient-evoked otoacoustic emissions are transmitted through the middle ear. The purpose of this study was to investigate the effects of dynamic properties of the transmission system on the measurability of transient otoacoustic emissions. The authors analyzed the presence of transient otoacoustic emissions in 48 children with serous otitis media regarding the tympanogram, presence and type of effusion and pure tone average findings. The results obtained in this research show the predominant absence of transient otoacoustic emissions in patients with type B tympanogram (69.1%) especially if the effusion is mucoid (77.5%) with the hearing loss of 15 decibel hearing level. This research shows that disorders in dynamic characteristics of the middle ear in patients with serous otitis obstruct the transmission of acoustic energy and affect the measurability of transient otoacoustic emissions, especially if the effusion is mucoid and hearing loss of 15 decibel hearing level.
