The Relationship Between Scoliosis, Spinal Bone Density, and Truncal Muscle Strength in Familial Dysautonomia Patients.

This combined retrospective and prospective study aimed to investigate the relationship between scoliosis, spinal bone mineral density (BMD), and truncal muscle strength in patients with familial dysautonomia (FD). A total of 79 FD patients (40 male, 39 female) aged 5-44 years were included. The severity of scoliosis, lumbar spine BMD (Z-score), and truncal muscle strength were assessed. Correlations were analyzed using Pearson's correlation coefficient. Inverse correlations were observed between scoliosis severity and BMD (r = - 0.328, p = 0.001), as indicated by increasingly negative Z-score values with worsening osteoporosis. There were also inverse correlations between scoliosis and truncal muscle strength (r = - 0.595, p < 0.001). The correlation between scoliosis and age was notable up to 22 years (r = 0.421, p = 0.01), but not in the older age group (22-44 years). Our study identified inverse correlations between osteoporosis and scoliosis, as well as between scoliosis and truncal muscle strength, in FD patients. These findings suggest that there may be a relationship between bone density, muscle strength, and the severity of spinal curvature in this population. While our results highlight the potential importance of early diagnosis and management of osteoporosis, and possibly the benefits of physical therapy to strengthen truncal muscles, further research is needed to determine the direct impact of these interventions on preventing the progression of scoliosis and its associated complications in FD patients. A long-term longitudinal study could provide more insights into these relationships and inform treatment strategies for FD patients.

Rehabilitation outcomes of stroke patients treated with multi-modal endovascular reperfusion therapy.

AIM: The aim of this study was to investigate the influence of multi-modal endovascular reperfusion therapy (MMRT) on functional outcomes following rehabilitation. METHODS: Data from 14 MMRT-treated patients were analyzed and compared to MMRT-ineligible, age and stroke severity-matched patients treated at the same Neurological and Rehabilitation departments. Neurological evaluation was assessed with the NIH stroke scale (NIHSS). Activity of daily living was measured using the FIMTM instrument. Functional outcome was measured using the modified Rankin scale (mRS). RESULTS: The baseline characteristics of both groups were similar. NIHSS scores were lower in the MMRT group and they had slightly better functional and rehabilitation scores on admission to rehabilitation. At the end of rehabilitation, more MMRT-treated patients reached functional independence (mRS≤2; 50% vs. 7% respectively P=0.03). FIM scores were also higher in the MMRT group (mean score 93.3 vs. 87.7, respectively) but the difference did not reach significance. The delta in FIM and NIHSS scores obtained during rehabilitation did not significantly differ between the groups. MMRT remained a significant modifier of good outcome after regression analysis (OR 21.5 95% CI 1.1-410). CONCLUSION: MMRT-treated patients have better chances of attaining independence after rehabilitation therapy. However, the additional improvements gained while in active rehabilitation were independent of reperfusion status.

Regional recurrences of N0 primary laryngeal cancer: a retrospective study of fiveyear period.

PURPOSE: To analyse the stage of nodal neck recurrences when first encountered and to determine the relevance of selective lateral neck dissection by retrospective review of patients with regional recurrence. PATIENTS AND METHODS: The files of patients with nodal neck metastases were retrospectively reviewed, covering a 5-year period (1991-1995). Chosen were cases with only regional recurrences of N0 primaries confined to the larynx and initially treated solely with resection of the primary. Cases in which regional recurrences were accompanied by local recurrences were excluded. We took into account T stage of the primary tumor, time to recurrence, recurrence localization, N status, presence of extracapsular spread, and distant metastases. RESULTS: For the period studied 310 patients with N0 laryngeal primaries were found. Thirty-eight (12.25%) cases developed regional recurrences and were consistent with the listed criteria. At the time of initial treatment 2 (5.3%) patients were T1, 3 (7.9%) T2, 27 (71%) T3, and 6 (15.8%) T4. The median time to recurrence was 13.1 months. The N stage of the recurrences was as follows: 4 (10%) patients had N1, 11 (29%) N2a, 8 (21%) N2b, 3 (8%) N2c, and 12 (32%) N3. Extracapsular spread was identified in 17 (43%) cases. CONCLUSION: In cases of advanced laryngeal carcinomas the wait-and-see policy is hazardous. In such cases it is advisable to perform simultaneous resection of the primary and elective neck dissection.

Stimulation electromyography as a method of intraoperative identification of the recurrent laryngeal nerve in thyroid surgery.

INTRODUCTION: The iatrogenic injury of the recurrent laryngeal nerve during thyroid surgery still represents a major problem because of the great physiologic and psychologic trauma to the patients. The incidence of this complication ranges between 1% and 15% depending on the thyroid pathology and type of surgery. AIM: To evaluate the potential of stimulation electromyography as a method of intraoperative prophylaxis of iatrogenic injuries of the recurrent laryngeal nerve. MATERIAL AND METHODS: Intraoperative monitoring of the recurrent laryngeal nerve based on stimulation electromyography, which was introduced in the Clinics of Surgery and Otorhinolaryngology at the Higher Medical Institute in Plovdiv, was applied in thyroid surgery using Neurosign 100 (Magstim Company Ltd., Wales, UK) apparatus. The study involved 5 experimental dogs and 73 recurrent laryngeal nerves in 47 patients treated in the clinics from November 1, 1999 to February 15, 2000. RESULTS: In all experimental animals and patients the electrical stimulation was successful triggering an "M" response of the laryngeal muscles (the vocal muscle). A stable contact was achieved between the recording (needle) electrodes and the vocal folds. None of the patients had signs of laryngeal palsy or complaints other from the usual in endotracheal intubation. CONCLUSION: The results suggest that the intraoperative stimulation electromyography of the recurrent laryngeal nerve is a safe and effective method for evaluation of the nerve integrity during and at the end of the operation.

Intraoperative identification of recurrent laryngeal nerves in thyroid surgery by electrical stimulation.

INTRODUCTION: Iatrogenic injury of the recurrent laryngeal nerve and its prevention is one of the controversial issues in thyroid surgery. The incidence of this operative complication ranges from 0.4% to 3.9%. PATIENTS AND METHODS: The authors analysed the results of the identification of 114 nerves in 60 patients who underwent thyroid surgery between July 9, 1999 and December 19, 2000 in the 3rd Surgical Clinic at the Department of Clinical Surgery and in the Department of Ear Nose and Throat Diseases of the Medical University in Plovdiv, Bulgaria. Nerve integrity monitor Neurosign 100 and specially designed EMG electrodes (Magstim Company Ltd., Wales, UK) were used. The patients were examined pre- and postoperatively for vocal cord paralysis by otolarygologist. RESULTS: In all patients electrical stimulation of the recurrent laryngeal nerve was successfully used for identification of the nerve and evaluation of its integrity during and at the end of the operation. No postoperative recurrent laryngeal nerve deficit was detected clinically. CONCLUSIONS: The results indicate that the identification of the recurrent laryngeal nerve by electromyography is a safe, effective and simple method for electrophysiologic monitoring during thyroid surgery. This method allows assessment of the neural integrity at the end of the procedure.

Endonasal surgery in mucopyocele of the paranasal sinuses.

INTRODUCTION: Mucopyocele of the paranasal sinuses generally develops as complication in patients with chronic inflammatory diseases of the paranasal sinuses, but could also be secondary to trauma, tumor or surgical manipulation. Surgery is the definitive method of cure. AIM: The aim of the study was to assess the endonasal microsurgical marsupialization in treatment of mucopyocele. MATERIAL AND METHODS: Five patients (3 females and 2 males) with mucopyocele of the frontal and/or ethmoidal sinuses were treated in the Department of Ear, Nose, and Throat Diseases at the Medical University in Plovdiv for the period 1996-1999. The process location was exactly defined by high-resolution computed tomography. Endonasal microendoscopic anterior ethmoidectomy with marsupialization was performed. In two patients (frontal sinus mucocele) the endonasal approach was combined with an extranasal approach keeping the functional principles. RESULTS: The control endoscopic and computer tomographic examinations did not show recurrence of the disease. CONCLUSION: Surgical approach in mucocele of the sinuses should be based on the findings of accurate computed tomography, rather than performed as a routine technique. This allows the operation to be particularized, trauma and duration of the operation reduced and function of the sinunasal system preserved.

Stimulation electromyography as a method of intraoperative localization and identification of the facial nerve during parotidectomy: review of 15 consecutive parotid surgeries.

INTRODUCTION: It has been widely recognized that one of the major hazards during operation of the parotid gland, mainly in tumor resection, is the injury of the facial nerve. Facial nerve monitoring has achieved wide application in otologic and neurotologic procedures to help localization and protection of the facal nerve in the temporal bone. MATERIAL AND METHODS: The authors analyze localization and identification of 15 nerves in 15 patients who underwent parotid gland surgery in the Department of Ear Nose and Throat Diseases of the Medical University in Plovdiv from September 15, 2000 to December 15, 2000. Nerve integrity monitor Neurosign 100 and specially designed electromyographic electrodes were used. RESULTS: In all patients stimulation electromyography of the facial nerve was successfully used to locate, identify and evaluate the integrity of the facial nerve during and at the end of the operation. No postoperative facial nerve injury was detected clinically. In two patients with parotid gland cancer the inferior division of the facial nerve was found infiltrated by the cancer growth. CONCLUSION: The results indicate that identification of the facial nerve by electromyography is a safe, effective and simple method of electrophysiologic monitoring during parotid gland surgery. This method allows assessment of the nerve integrity at the end of the operation.

Selective neck dissection in treatment of node-positive neck cases.

Surgical management of patients with cervical metastases of laryngeal and hypolaryngeal cancer has remained a challenge ever since Dr. Crile described the radical neck dissection. The evolution of neck dissection technique confirms this statement. The modification of the radical neck dissection is justified by the severe cosmetic and functional losses related to it and by the fact that despite the comprehensiveness, the recurrences in the neck are still a significant problem. Applying selective neck dissection in node positive cases seems to be justifiable. Expanding the indications for this operation is justified, because in the absence of factors that have destructive effect on fascial compartments of the neck or disrupt the lymphatic flow, such as gross adenopathy or significant extracapsular spread, the principles on which the selective neck dissection is based are still valid. In this paper we report our experience with 10 patients with N1 and N2 who underwent supraomohyoid and lateral neck dissections with follow-up of at least 2 years.

A case of aspergillosis of the nose and paranasal sinuses.

Until recently aspergillosis of the paranasal sinuses has been considered a rare disease but nowadays it is frequently discussed in the literature. The reason is the nonspecific clinical course of the disease resembling recurrent chronic rhinosinusitis and its difficult histological and radiological verification. Although there have been clinical suspicions of this diseases in quite a few patients presenting with recurrent polyposis of the sinuses associated with aspirin intolerance and bronchial asthma we could prove sinus aspergillosis histologically and computed-tomographically only in one patient.

Microsurgical technique as a method for prevention of recurrent laryngeal nerve injury in thyroid surgery. Review of seven consecutive cases.

INTRODUCTION: Vocal cord paresis or paralysis due to iatrogenic injury of the recurrent laryngeal nerve is one of the main problems in thyroid surgery. Although many procedures have been introduced to prevent the nerves from lesion the incidence of recurrent laryngeal nerve palsy varies between 1.5-14%. The aim of the study was to evaluate the role of the microsurgical technique as a method, which can help the surgeon to identify the recurrent laryngeal nerve in the operative field. MATERIAL AND METHODS: Fourteen nerves in 7 patients were identified with Zeiss multidiscipline universal surgical microscope with a 250-mm ocular lens. All were female patients with mean age of 35 years (Range 16-53) and diagnosis papillary cancer. They were admitted and operated in the Department of Ear, Nose, and Throat Diseases of the Higher Medical Institute in Plovdiv, Bulgaria. RESULTS: In all patients the recurrent laryngeal nerves were successfully identified along their whole length from the inferior thyroid artery to their entering the laryngeal muscles. None of the patients had temporary or permanent vocal cord palsy. CONCLUSION: Microsurgical technique could be a procedure of great value for prevention of the recurrent laryngeal nerves during thyroid surgery, especially in reoperations, thyroid cancer or retrosternal goitre.

Anatomo-topographic landmarks on the lateral wall of nasal cavity used in endonasal surgery.

INTRODUCTION: A dissection of the lateral wall of nasal cavity that imitates a true endonasal operation was the design of the present study. The object of the study was by measuring the distance between a pivot landmark and important anatomical structures revealed successively during an endonasal operation to create additional highlights that will minimise the hazard of injuring vital structures. METHODS: Twenty anatomical preparations of sagittally sectioned heads from cadavers (elderly males of Bulgarian origin) were dissected to study the topographic relationships between the great paranasal cavities (maxillary, frontal, and sphenoidal sinus) and the ethmoidal labyrinth. Using punctum subnasale as a pivot landmark, the distances to crucial microendoscopic landmarks (i.e., nasolacrimal duct, uncinate process, ethmoidal bulla, base of the skull, anterior wall of the sphenoid sinus, orifice of the maxillary sinus) were measured at different angles to the horizontal plane. RESULTS: The mean distances from punctum subnasale to the natural ostium of the maxillary sinus and anterior wall of the sphenoidal sinus, measured at an angle of 30 degrees to the floor of the nasal cavity, were 48.25 +/- 0.75 and 67.105 +/- 0.794 mm, respectively. At an angle of 45 degrees, the mean distance to the nasolacrimal duct was 38.056 +/- 0.591 mm; to the uncinate process 45.25 +/- 0.57 mm; to the ethmoidal bulla 50.25 +/- 0.57 mm; and to the base of the skull 66.053 +/- 0.818 mm. Mean distance of 43.158 +/- 0.568 mm to the lacrimal sac and 60.25 +/- 0.68 mm to the base of the skull were measured at an angle of 60 degrees. CONCLUSION: The analysis of the results imply that the selected distances will contribute to a more precise application of this contemporary surgical method.

The application of ferrihydroxamic complexes to photocolorimetric determination of drugs. Part 2: Quantitative determination of calcium pangamate (vitamin B15) and its calcium gluconate mixtures.

A quantitative method for calcium pangamate (Vitamin B15) and calcium gluconate determination, separately and in mixture, is proposed on the basis of the ferric hydroxamate procedure. The method may also be applied to the determination separately and in mixture, is proposed on the basis of the ferric of both preparations in mixture with various other substances which are not converted into lactone from in acid medium, and which the ferric hydroxamate procedure fails to develop.