No description available.

Background: Caustic ingestions are rare but potentially life-threatening events requiring multidisciplinary emergency approaches. Although particularly respiratory functions may be impaired after caustic ingestions, studies involving acute emergency care are scarce. The goal of this study was to explore acute emergency care with respect to airway management and emergency department (ED) infrastructures. Methods: We retrospectively evaluated adult patients after caustic ingestions admitted to our university hospital over a 10-year period (2005–2014). Prognostic analysis included age, morbidity, ingested agent, airway management, interventions (endoscopy findings, computed tomography (CT), surgical procedures), intensive care unit (ICU) admission, length of stay in hospital and hospital mortality. Results: Twenty-eight patients with caustic ingestions were included in the analysis of which 18 (64 %) had suicidal intentions. Ingested agents were caustic alkalis (n = 22; 79 %) and acids (n = 6; 21 %). ICU admission was required in 20 patients (71 %). Fourteen patients (50 %) underwent tracheal intubation and mechanical ventilation, of which 3 (21 %) presented with difficult airways. Seven patients (25 %) underwent tracheotomy including one requiring awake tracheotomy due to progressive upper airway obstruction. Esophagogastroduodenoscopy (EGD) was performed in 21 patients (75 %) and 11 (39 %) underwent CT examination. Five patients (18 %) required emergency surgery with a mortality of 60 %. Overall hospital mortality was 18 % whereas the need for tracheal intubation (P = 0.012), CT-diagnostic (P = 0.001), higher EGD score (P = 0.006), tracheotomy (P = 0.048), and surgical interventions (P = 0.005) were significantly associated with mortality. Conclusions: Caustic ingestions in adult patients require an ED infrastructure providing 24/7-availability of expertise in establishing emergent airway safety, endoscopic examination (EGD and bronchoscopy), and CT diagnostic, intensive care and emergency esophageal surgery. We recommend that - even in patients with apparently stable clinical conditions - careful monitoring of respiratory functions should be considered as long as diagnostic work-up is completed.

Referat: Starre und flexible Endoskopien gehören heutzutage zu den Standarduntersuchungen in der HNO-Heilkunde. Mit der Weiterentwicklung und vermehrten Anwendung von TLM (transoral surgery) und TORS (transoral robotic surgery), gewinnt die präoperative Vermessung von Befunden an Wichtigkeit. Trotz mehrerer wissenschaftlicher Studien konnte bisher noch keine befriedigende standardisierte Methode zur endoskopischen Vermessung der oberen Atemwege gefunden werden. Bisher ließen optische und technische Umstände eine objektive endoskopische Vermessung nicht zu. Ziel dieser Studie ist es, transorale Vermessungen mittels Multipoint-Laser-Endoskop auf Genauigkeit und Anwendbarkeit zu überprüfen. In der vorliegenden Studie wurde ein Multipoint-Laser-Endoskop verwendet, das 49 Laserpunkte (Wellenlänge 639 nm, Leistung < 5 mW) in die optische Achse des Endoskopbildes projiziert. Durch die Erstellung eines 3D-Koordinatensystems können im Endoskopbild sowohl Strecken-, als auch Tiefen- und Flächenmessungen in Echtzeit vorgenommen werden. Nach einem Modellversuch erfolgten endoskopische Vermessungen an neun Leichenpräparaten im Bereich von Larynx und Trachea, die im Anschluss mit CT-Vermessungen verglichen wurden. Sieben der neun Leichenpräparate konnten für die Auswertung genutzt werden. Dabei ergab sich ein optimaler Messabstand von Endoskopspitze zu untersuchtem Objekt von 5-6 cm. Der durchschnittliche Messfehler lag bei 3.26 % ± 2.53 %. Der Vergleich mit den CT-Vermessungen ergab hervorragende Spearman-Korrelationskoeffizienten von 0.95 (p = 0.01) für die Larynxvermessung und 0.93 (p < 0.01) für die Trachealvermessung. Zusammenfassend lässt sich die Multipoint-Laser-Vermessung als eine vielversprechende Methode für den täglichen Einsatz in der diagnostischen und chirurgischen HNO einschätzen.

Background: Endoscopic band ligation (EBL) is generally accepted as the treatment of choice for bleeding from esophageal varices. It is also used for secondary prophylaxis of esophageal variceal hemorrhage. However, there is no data or guidelines concerning endoscopic control of ligation ulcers. We conducted a retrospective study of EBL procedures analyzing bleeding complications after EBL. Methods: We retrospectively analyzed data from patients who underwent EBL. We analyzed several data points, including indication for the procedure, bleeding events and the time interval between EBL and bleeding. Results: 255 patients and 387 ligation sessions were included in the analysis. We observed an overall bleeding rate after EBL of 7.8%. Bleeding events after elective treatment (3.9%) were significantly lower than those after treatment for acute variceal hemorrhage (12.1%). The number of bleeding events from ligation ulcers and variceal rebleeding was 14 and 15, respectively. The bleeding rate from the ligation site in the group who underwent emergency ligation was 7.1% and 0.5% in the group who underwent elective ligation. Incidence of variceal rebleeding did not vary significantly. Seventy-five percent of all bleeding episodes after elective treatment occurred within four days after EBL. 20/22 of bleeding events after emergency ligation occured within 11 days after treatment. Elective EBL has a lower risk of bleeding from treatment-induced ulceration than emergency ligation. Conclusions: Patients who underwent EBL for treatment of acute variceal bleeding should be kept under medical surveillance for 11 days. After elective EBL, it may be reasonable to restrict the period of surveillance to four days or even perform the procedure in an out-patient setting.

Indiana University-Purdue University Indianapolis (IUPUI) / A novel algorithm was developed to convert raw 2-dimensional endoscope videos into 3-dimensional view. Minimally invasive surgeries aided with 3D view of the invivo site have shown to reduce errors and improve training time compared to those with 2D view. The novelty of this algorithm is that two cues in the images have been used to develop the 3D. Illumination is the rst cue used to nd the darkest regions in the endoscopy images in order to locate the vanishing point(s). The second cue is the presence of ridge-like structures in the in-vivo images of the endoscopy image sequence. Edge detection is used to map these ridge-like structures into concentric ellipses with their common center at the darkest spot. Then, these two observations are used to infer the depth of the endoscopy videos; which then serves to convert them from 2D to 3D. The processing time is between 21 seconds to 20 minutes for each frame, on a 2.27GHz CPU. The time depends on the number of edge pixels present in the edge-detection image. The accuracy of ellipse detection was measured to be 98.98% to 99.99%. The algorithm was tested on 3 truth images with known ellipse parameters and also on real bronchoscopy image sequences from two surgical procedures. Out of 1020 frames tested in total, 688 frames had single vanishing point while 332 frames had two vanishing points. Our algorithm detected the single vanishing point in 653 of the 688 frames and two vanishing points in 322 of the 332 frames.

Purpose To report contemporary epidemiological data and treatment trends for upper tract urothelial carcinoma (UTUC) in Germany over a 14-year period. Methods We analyzed data from the nationwide German hospital billing database and the German cancer registry from 2006 to 2018/2019. The significance of changes over time was evaluated via regression analysis. Survival outcomes were calculated using the Kaplan–Meier method. Results There was a non-significant increase in the age-standardized incidence rate from 2.5/100,000 in 2006 to 2.9/100.000 in 2018. 13% of patients presented with lymph node metastasis and 7.6% of patients presented with distant metastasis at primary diagnosis. The 5-year overall survival was estimated at 45% and the 10-year overall survival at 32%. Endoscopic biopsies of the renal pelvis and ureter as well as ureteroscopies with excision/destruction of UTUC all increased significantly over the study period. The number of radical nephroureterectomies (RNU) for UTUC steadily increased from 1643 cases in 2006 to 2238 cases in 2019 (p < 0.005) with a shift from open surgery towards minimally invasive surgery. Complex reconstructive procedures like ileal ureter replacement or autotransplantation are rarely performed for urothelial carcinoma of the ureter. Conclusion Diagnostic and therapeutic procedures for UTUC have increased and minimally invasive nephroureterectomy is the predominant approach concerning radical surgery in 2019.

Une cicatrice apparente au cou après une chondrolaryngoplastie chez une femme transgenre a le pouvoir d’agir comme stigmatisation pour cette population et peut provoquer une détresse psychologique importante. L’approche sans cicatrice du cou antérieur a été décrite dans les dernières années comme sécuritaire et efficace pour la chirurgie thyroïdienne, via une approche endoscopique transvestibulaire. À notre connaissance, cette approche est encore très peu étudiée pour la chondrolaryngoplastie. Avec cette étude, nous avons cherché à détailler et évaluer la faisabilité d'une chondrolaryngoplastie via une approche transvestibulaire. Trois cadavres mâles ont été utilisés pour cette étude. Une approche endoscopique transvestibulaire, utilisant trois trocarts insérés dans la région vestibulaire, a été réalisée. Une dissection mousse dans le plan sous-platysmal et la division des muscles de la sangle ont été effectuées pour exposer le cartilage thyroïdien. Une laryngoscopie directe a été réalisée avec une lame Mac standard. Une aiguille a ensuite été insérée à travers la peau et le cartilage thyroïdien afin de confirmer le niveau de la commissure antérieure sur le cartilage thyroïdien avant de poursuivre. Enfin, le cartilage thyroïdien a été poli à l'aide d'un microdébrideur et l’étendue a été guidée par l'apparence du cou antérieur et la position de l'aiguille. Le cartilage thyroïdien des trois cadavres était significativement réduit après l’intervention et la commissure antérieure a été préservée. Cette approche transvestibulaire est une technique réalisable pour la chondrolaryngoplastie, permet une chirurgie sans cicatrice cervicale et permet au chirurgien de confirmer la position de la commissure antérieure avant de procéder à l’intervention. Nous pensons qu'il s'agit d'une chirurgie prometteuse pour les femmes transgenres. / An apparent neck scar following chondrolaryngoplasty can cause significant psychological distress. For thyroid surgery, a scarless transvestibular endoscopic approach to the anterior neck has already been described as safe and efficient. With this study, we sought to describe and assess the feasibility of a transvestibular approach for chondrolaryngoplasty. Three male cadavers were used for this study. A transvestibular endoscopic approach, using three trocarts inserted in the vestibular region of the inferior lip was performed. A blunt dissection in the subplatysmal plane with division of the strap muscles was completed to expose the thyroid cartilage. A direct laryngoscopy was performed with a standard Mac blade. A needle was then inserted through the skin and the thyroid cartilage to confirm the level of the anterior commissure on the thyroid cartilage before proceeding. Finally, the laryngeal prominence was reduced using a powered shaver. The amount of cartilage to be removed was guided by the appearance of the anterior neck and the position of the needle. The thyroid cartilage appeared significantly reduced after the procedure and the attachment of the anterior commissure was safely preserved. This transvestibular approach is a feasible technique for chondrolaryngoplasty, allows a scarless surgery and allows the surgeon to confirm the position of the anterior commissure before proceeding. We believe this is a promising surgery for transgender women.

No description available.

Objective. This study aimed to determine the predictors of olfactory improvement after endoscopic sinus surgery among patients with chronic rhinosinusitis with nasal polyps. Method. This prospective cohort study included patients admitted to a university hospital between 2006 and 2012. Assessment using odour identification testing, a sinonasal symptom questionnaire, the Rhinosinusitis Disability Index and mucus biomarker levels was performed at various time points. Correlation of variables with identification score differences at six postoperative time points and at baseline was performed, followed by multiple linear regression to determine significant predictors at each of the six post-operative time points. Results. Baseline absence of acute sinusitis, elevated serpin F2 and anterior rhinorrhoea predict early olfactory improvement, whereas baseline allergic rhinitis predicts late olfactory improvement. Baseline odour identification score was the strongest predictor across all time points. Conclusion. Patients with chronic rhinosinusitis and nasal polyps with worse disease or baseline olfactory function may benefit more from endoscopic sinus surgery in terms of olfactory improvement.

<p>Акутни панкреатитис је ензиматско инфламаторно оболење панкреаса, са инциденцијом око 17/100000 становника. Најчешћи етиолошки чиниоци који се везују за ово стање су билијарна калкулоза (45%) и конзумација алкохолних пића (35%). Ређи узроци су одређени лекови, хипертриглицеридемија, хиперкалијемија, траума, урођени чиниоци, и идиопатски панкреатитис (20%). По међународној Атланској (Atlanta) класификацији, акутни панкреатитис се може манифестовати у умереној, умерено тешкој и тешкој форми. Умерене форме панкреатитиса се јављају у 80%, карактеришу се едемом органа и имају благ и краткотрајан клинички ток, са стопом морталитета од 1%. Основни циљ лечења болесника са акутним панкреатитисом у прва 24 сата хоспитализације јесте олакшавање тегоба, утврђивање узрока панкреатитиса и процена тежине обољења. Акутни панкреатитис билијарне етиологије узрокован је калкулозом жучне кесе и/ или жучних путева. Препоручени третман билијарне калкулозе, у циљу превенције поновног атака умерене форме билијарног панкреатитиса , подразумева уклањање жучне кесе лапароскопском холецистектомијом са интраоперативном холангиографијом. Уколико се дијагностикује калкулоза жучних канала ради се ендоскопска ретроградна холангиопанкреатографија (ЕРЦП) са ендоскопском папилотомијом (ЕПТ) и уклањем__ калкулуса и детритуса уз жучних водова, са циљем обезбеђивања нормалног протока жучи у дванаестопалачно црево. Циљ овог истраживања је оптимализација редоследа примене ЛХ и ЕРЦП са ЕПТ, идентификацијом предикционих показатеља холедохолитијазе, ради скраћења дужине хоспитализације болесника са умереном формом акутног билијарног панкреатитиса. У спроведеној проспективној анамнестичкој студији, учествовало је 100 болесника лечених од умерене форме акутног билијарног панкреатитиса, у Ургентном центру Клиничког центра Војводине, од 2011. до 2015.године, од којих је код 80 урађена само ЛХ, а код 20 ЛХ и ЕРЦП са ЕПТ. Анализом клиничких, ултразвучних и лабораторијских налаза, идентификовано је 5 статистички значајних предиктора холедохолитијазе; директни и укупни билирубин, алкална фосфатаза (АФ), гама глутирил транспепдидаза (гама ГТ) и це реактивни протеин (ЦРП), на основу којих је омогућено креирање математичког модела за предикцију холедохолитијазе, коришћењем теорије потпорних вектора (СВМ). Установљено је да патолошки налази ових параметара значајно указују на холедохолитијазу, те да је ЛХ препоручена као метода првог избора, код болесника код којих налази предиктора холедохолитијазе нису патолошки. Овако лечени болесници су имали значајно краће време хоспитализације. Поред тога, уколико се интраоперативном холангиографијом (ИОХ) при ЛХ установи холедохолитијаза, ЕРЦП са ЕПТ се може урадити без одлагања.</p> / <p>Akutni pankreatitis je enzimatsko inflamatorno obolenje pankreasa, sa incidencijom oko 17/100000 stanovnika. Najčešći etiološki činioci koji se vezuju za ovo stanje su bilijarna kalkuloza (45%) i konzumacija alkoholnih pića (35%). Ređi uzroci su određeni lekovi, hipertrigliceridemija, hiperkalijemija, trauma, urođeni činioci, i idiopatski pankreatitis (20%). Po međunarodnoj Atlanskoj (Atlanta) klasifikaciji, akutni pankreatitis se može manifestovati u umerenoj, umereno teškoj i teškoj formi. Umerene forme pankreatitisa se javljaju u 80%, karakterišu se edemom organa i imaju blag i kratkotrajan klinički tok, sa stopom mortaliteta od 1%. Osnovni cilj lečenja bolesnika sa akutnim pankreatitisom u prva 24 sata hospitalizacije jeste olakšavanje tegoba, utvrđivanje uzroka pankreatitisa i procena težine oboljenja. Akutni pankreatitis bilijarne etiologije uzrokovan je kalkulozom žučne kese i/ ili žučnih puteva. Preporučeni tretman bilijarne kalkuloze, u cilju prevencije ponovnog ataka umerene forme bilijarnog pankreatitisa , podrazumeva uklanjanje žučne kese laparoskopskom holecistektomijom sa intraoperativnom holangiografijom. Ukoliko se dijagnostikuje kalkuloza žučnih kanala radi se endoskopska retrogradna holangiopankreatografija (ERCP) sa endoskopskom papilotomijom (EPT) i uklanjem__ kalkulusa i detritusa uz žučnih vodova, sa ciljem obezbeđivanja normalnog protoka žuči u dvanaestopalačno crevo. Cilj ovog istraživanja je optimalizacija redosleda primene LH i ERCP sa EPT, identifikacijom predikcionih pokazatelja holedoholitijaze, radi skraćenja dužine hospitalizacije bolesnika sa umerenom formom akutnog bilijarnog pankreatitisa. U sprovedenoj prospektivnoj anamnestičkoj studiji, učestvovalo je 100 bolesnika lečenih od umerene forme akutnog bilijarnog pankreatitisa, u Urgentnom centru Kliničkog centra Vojvodine, od 2011. do 2015.godine, od kojih je kod 80 urađena samo LH, a kod 20 LH i ERCP sa EPT. Analizom kliničkih, ultrazvučnih i laboratorijskih nalaza, identifikovano je 5 statistički značajnih prediktora holedoholitijaze; direktni i ukupni bilirubin, alkalna fosfataza (AF), gama glutiril transpepdidaza (gama GT) i ce reaktivni protein (CRP), na osnovu kojih je omogućeno kreiranje matematičkog modela za predikciju holedoholitijaze, korišćenjem teorije potpornih vektora (SVM). Ustanovljeno je da patološki nalazi ovih parametara značajno ukazuju na holedoholitijazu, te da je LH preporučena kao metoda prvog izbora, kod bolesnika kod kojih nalazi prediktora holedoholitijaze nisu patološki. Ovako lečeni bolesnici su imali značajno kraće vreme hospitalizacije. Pored toga, ukoliko se intraoperativnom holangiografijom (IOH) pri LH ustanovi holedoholitijaza, ERCP sa EPT se može uraditi bez odlaganja.</p> / <p>Acute pancreatitis is an enzymatic inflammatory disease of the pancreas, with an incidence of around 17/100000 inhabitants. The most common etiological factors that are associated with this condition are biliary calculi (45%) and consumption of alcoholic beverages (35%). Less common causes include certain medications, hypertriglyceridemia, hyperkalemia, trauma, congenital factors and idiopathic pancreatitis (20%). According to the Atlanta International classification, acute pancreatitis can be manifested in a moderate, moderately severe and severe forms. Moderate forms of pancreatitis occur in 80%, characterized by pancreatic edema and have mild and short clinical course, with a mortality rate of 1%. The main goal of treatment of patients with acute pancreatitis in the first 24 hours of hospitalization is to facilitate complaints, determining the cause of pancreatitis and assessment of severity of the disease. Acute biliary pancreatitis is caused by calculosis of the gallbladder and / or bile ducts. The recommended treatment of biliary calculi, in order to prevent repeated attacks of moderate biliary pancreatitis, involves the removal of the gallbladder thru laparoscopic cholecystectomy with intraoperative cholangiography. If presence of bile duct calculi is established, an endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic papillotomy (EPT) and removes stones and detritus along the bile ducts is indicated, with the aim of ensuring the normal flow of bile into the duodenum. The aim of this study is the optimization of the order of application LH and ERCP with EPT, the identification of predictable indicators of choledocholithiasis, in order to shorten the length of hospitalization of patients with a moderate form of acute biliary pancreatitis. We conducted prospective case control study, with 100 patients involved, treated for moderate forms of acute biliary pancreatitis in the Emergency Center of the Clinical Center of Vojvodina, from 2011 to 2015, of which 80 made only with LH and 20 with LH at and ERCP with EPT . The analysis of clinical, ultrasound and laboratory findings identified 5 significant predictors of choledocholithiasis; direct and total bilirubin, alkaline phosphatase (AF), gamma glutiril transpepdidase (gamma GT) and C reactive protein (CRP), under which enabled the creation of a mathematical model for predicting choledocholithiasis, using the Support vector machines (SVM). It was found that pathological findings of these parameters indicate a significant choledocholithiasis, and LH is recommended as the first choice in patients in whom there are not present pathological predictors of choledocholithiasis. Thus treated patients had a significantly shorter hospital stay. In addition, if the intraoperative cholangiography (IOH) during LH show choledocholithiasis, ERCP with the EPT can be done without delay.</p>