Osteoma of mastoid process obstructing external auditory canal: A case report

Objective: To discuss the surgical treatment of recurrent osteoma of the mastoid process of the temporal bone, that obstructed external auditory canal causing unilateral conductive hearing loss. Setting: The study was carried out in ENT Clinic, University Clinical Center of Kosovo, Prishtina, Kosovo. Design: Retrospective review of a clinical case. Patient, Intervention and Result: We treated surgically with success a 14-year-old boy with osteoma of mastoid process, obstructing the external auditory canal of the left ear and causing conductive hearing loss. Axial and coronal computed tomography scans revealed an compact bone lesion that obstructed the canal. Complete removal of the lesion was achieved by a retroauricular approach. Conclusion: In order to achieve complete removal of the osteoma, drilling of the lesion must be performed not through the tumor, but around the osteoma, in the surrounding bone tissue.

One stage reconstruction of large lower lip carcinoma, with local flaps

Squamous cell carcinoma (SCC) of the lower lip is a frequently diagnosed malignant pathology in the maxillofacial region. It is a slow-growing cancer, and can be diagnosed and treated easily and effectively;however, early treatment is important because its mortality rate is 10%-30%. Reconstruction for a large lower lip defect is surgically challenging, especially reconstruction with local flaps. Here, we present a 52-year-old male with a large T3 SCC, which started 13 years before this treatment and involved nearly all of his lower lip, oral commissure and upper lip. It was reconstructed by local flaps with good aesthetic and functional results. The lip was reconstructed with a combination of a Karapandzic flap on one side and a contralateral Webster cheek advancement, using a functional neck dissection on the tumor side and supraomohyoid neck dissection contralaterally. Histopathology results of the neck were negative for metastasis. We were satisfied with the aesthetic and functional results of the neck.

Impact of Local Application of Clindamycin in Preventing Dry Socket after Third Mandibular Molar Extraction

Extraction of third mandibular tooth is one of the most commonly performed surgical procedures in oral surgery. One of the most common complications following the extraction of third mandibular molar teeth is dry socket (alveolar osteitis). Dry socket is the delayed healing of the wound of the alveolar bone after dental extractions. The purpose of this study was to determine if the intra-alveolar application of Clindamycin could reduce the incidence of dry socket following the extraction of third mandibular molar tooth. Patients who qualified for the prospective, randomized, double-masked, placebo-controlled trial were randomly divided into 2 groups, each group 30 patients. The first group (30 patients) included smokers and the second group (30 patients) included non smokers. Both groups had the mandibular third molar extracted in both sides at the same time. In total, 120 third molars were extracted. The left site was a study group in which we applied the clindamycin and the right site was a control group. The patients were also divided by gender. Dry socket occurred in 3.3% of cases for patients whom were given Clindamycin, regardless of their smoking habits, as opposed to 31.7% for those who did not receive the antibiotic. Results clearly showed that Clindamycin had a huge impact on reducing dry socket regardless of smoking habits.

The Efficacy of 1% Chlorhexidine Gel on the Reduction of Dry Socket Occurence Following Surgical Third Molar Extraction—Pilot Study

Aim & Objectives: The aim of this prospective pilot-study was to assess the efficacy of intra alveolar application of 1% chlorhexidine gel (CHX) on the reduction of dry socket (DS) occurrence following surgical extraction of mandibular third molars. Materials and Methods: A randomized split-mouth-design study included twenty-five patients with bilaterally impacted lower third molars (partial or full bone) requiring full thickness mucoperiastal flap reflection for extraction. Following surgical extraction of third lower molar, 2 ml of gel containing 1% chlorhexidine digluconate (Chlorhexamed? Gel 1%) were placed in the experimental side, and saline solution was used for irrigation in the control side of extraction sockets, both followed by suturing of extraction site. The surgeries and follow up examinations were performed by the same surgeon. The follow up visits were performed at 48 hours and on day seven, post surgery where presence or absence of dry socket using the Blum criteria for diagnosis was evaluated and pain intensity by Visual Analogue Scale (VAS) 0 - 100 was observed. Results: In this pilot study, dry socket was present in 4.0 and 28.0% of cases in the experimental and control groups, respectively (P = 0.048). Fisher’s test revealed a statistically significant reduction of dry socket occurrence following the use of 1% CHX gel versus saline solution. Conclusion: The application of CHX gel 1% may significantly reduce the incidence of DS following third molar extraction. Prophylactic use of CHX gel 1% may be suggested in all patients, especially in the patients at risk of development of DS.

Treatment of Conjunctival Malignant Melanoma with Topical Interferon Alpha-2a

Conjunctival malignant melanoma (CMM) is a potentially lethal neoplasm with a high rate of recurrence. The modality of treatment includes a wide surgical excision, cryotherapy, topical mitomycin C and Interferon alpha 2b (INF α 2b). The aim of the study is to present the treatment of a case with CMM using topical Interferon alpha 2a. We present a 38-year-old female with diffuse bulbar dark pigmentation of the conjunctiva that arises from previously primary acquired melanosis (PAM). Biopsy resulted positive for CMM and further investigations were negative for any metastasis. Treatment with topical interferon alpha 2a was started immediately and after three months melanoma disappeared. One year after follow-up there was no sign of recurrence in regional lymph nodes or distant metastasis.

Symptomatic subserosal gastric lipoma successfully treated with enucleation

Gastric lipomas are rare tumors, accounting for 2%-3% of all benign gastric tumors. They are of submucosal or extremely rare subserosal origin. Although most gastric lipomas are usually detected incidentally, they can cause abdominal pain, dyspeptic disorders, obstruction, invagination, and hemorrhages. Subserosal gastric lipomas are rarely symptomatic. There is no report on treatment of subserosal gastric lipomas in the English literature. We present a case of a 50-year-old male with symptomatic subserosal gastric lipoma which was successfully managed with removal, enucleation of lipoma, explorative gastrotomy and edge resection for histology check of gastric wall. The incidence of gastric lipoma, advanced diagnostic possibilities and their role in treatment modalities are discussed.

Gut-liver axis improves with meloxicam treatment after cirrhotic liver resection

AIM:To investigate the effect of meloxicam on the gut-liver axis after cirrhotic liver resection.METHODS:Forty-four male Wistar rats were assigned to three groups:(1)control group(CG);(2)bile duct ligation with meloxicam treatment(BDL+M);and(3)bile duct ligation without meloxicam treatment(BDL).Secondary biliary liver cirrhosis was induced via ligatureof the bile duct in the BDL+M and BDL groups.After 2wk,the animals underwent a 50%hepatectomy.In the BDL+M group 15 min prior to the hepatectomy,one single dose of meloxicam was administered.Parameters measured included:microcirculation of the liver and small bowel;portal venous flow(PVF);gastrointestinal(GI)transit;alanine aminotransferase(ALT);malondialdehyde;interleukin 6(IL-6),transforming growth factor beta 1(TGF-β1)and hypoxia-inducible factor 1 alpha(HIF-1α)levels;mRNA expression of cyclooxigenase-2(COX-2),IL-6 and TGF-β1;liver and small bowel histology;immunohistochemical evaluation of hepatocyte and enterocyte proliferation with Ki-67 and COX-2 liver expression.RESULTS:Proliferative activity of hepatocytes after liver resection,liver flow and PVF were significantly higher in CG vs BDL+M and CG vs BDL group(P<0.05),whereas one single dose of meloxicam ameliorated liver flow and proliferative activity of hepatocytes in BDL+M vs BDL group.COX-2 liver expression at 24h observation time(OT),IL-6 concentration and mRNA IL-6 expression in the liver especially at 3 h OT,were significantly higher in BDL group when compared with the BDL+M and CG groups(P<0.01,P<0.001,P<0.01,respectively).Liver and small bowel histology,according to a semi quantitative scoring system,showed better integrity in BDL+M and CG as compared to BDL group.ALT release and HIF-1αlevels at 1 h OT were significantly higher in BDL+M compared to CG and BDL group(P<0.001 and P<0.01,respectively).Moreover,ALT release levels at 3 and 24 h OT were significantly higher in BDL group compared to CG,P<0.01.GI transit,enterocyte proliferative activity and number of goblet cells were in favor of meloxicam treatment vs BDL group(P<0.05,P<0.001,P<0.01,respectively).Additionally,villus length were higher in BDL+M as compared to BDL group.CONCLUSION:One single dose of meloxicam admin-istered after cirrhotic liver resection was able to cause better function and integrity of the remaining liver and small bowel.

Carpal tunnel syndrome: Diagnosis and surgical treatment

Carpal tunnel syndrome (CTS) is a compressive idiopathic neuropathy, most commonly affecting the median nerve in the upper extremity. CTS have high prevalence, with up to 70% of cases in women aged between 45 and 60 years. Typical manifestations of CTS are numbness of the index and middle fingers, which also become painful and cause the patient to awaken from sleep. In the period from January 2008 to October 2011 at the Orthopedics Clinic of the University of Kosovo, surgery for decompression of the median nerve was performed for 32 patients with CTS. The patients had an average age of 49.1 years. After surgery, 81.25% of the patients experienced complete improvement, whereas partial improvements were noted in 18.75% of the patients. This treatment is easy and feasible, has high efficiency, can be performed under local anaesthesia, and confers improvements in terms of return to daily activities, with low risk of complications or relapse.

MRI and CT into Pathology Tumor and Liver Bile Duct

Background: Tumor pathologies of the liver and bile ducts are relatively commonly diagnosed and the primary goal is to differentiate these lesions in the fastest possible time which determines the apropriate method of treatment. Aims and Objectives: Aim of this study is tracking and diagnostic imaging correlation of tumor pathologies of liver and bile ducts and determining the early diagnostic approach. Data obtained from this study are important for treatment procedures and succes of treatment. All cases with liver tumor pathologies from period 2012-2016 were examined with CT and MRI followed by other complementary imaging methods. Methods: CT examination was performed according to standard triple-phase protocol: non-enhanced phase, arterial phase and porto-venous phase, and in some cases with late phase after 5 minutes. In MRI examinations, standard protocol was performed: coronal T2 single-shot fast spin-echo (coronal T2 SSFs), Axial T2 respiratory-triggered fast spin-echo (axial T2-FRE)/or breath-hold fast-recovery fast spin-echo T2 body coil sizes XL, (axial T2-FRFSE-XL), Axial in-phase/out-of-phase, Axial/ coronal three-dimensional liver acquisition with volume acceleration (3D coronal pre lava). Results: For comparation, only patients with liver focal lesions were included in the study, and and patient were examined with both diagnostic imaging modalities (CT and MRI). 168 patients with liver tumor pathologies and biliary tree tumor pathologies are included in the study. Gender ratio was 85 males and 83 female (M/F ratio 1.03:1). Average age of patients was 58.41 years, (minimum age 1.5 years old and maximum 88 years of age). The most frequent age on diagnosis was 61 - 70 years (total of 49 patients or 29.16%). Benign tumors were found with 93 patients (55.35%) and malignant tumors in 79 patients (47.02%). Distribution in liver parenchyma was found in 113 patients (67.26%), while in 49 patients (29.17%) pathology was found in the biliary tract. The most affected liver segment was the fifth segment in 35 patients (20.83%), while the less affected segment was the second liver segment in 8 patients (4.73%). most of patients (62 patients or 36.90%) had more than two affected segments in time of diagnosis. Diagnostic criteria in this study require further future evaluation. Conclusion: Early diagnosis of are tumors remains a real challenge and has great impact in the survival rate of patients. Finally, our study showed that for our country’s institutions that there was no significant difference between both CT and MRI modalities in liver focal lesions assessment.