Background: Melanotic neuroectodermal tumor of infancy (MNTI) is a rare, pigmented tumor, usually located in premaxilla during the first year of life.The cranial bones are less frequently involved.They usually have aggressive growth with bone destruction and expansion to neighboring tissues.They may have relapses, but most are benign.The goal of this publication is to provide immunohistochemical findings in two cases. Subjects and methods:The biopsies from A 16-month girl with a pigmented maxillary tumor and a 4 month baby with a tumor in the right temporal bone were analyzed in the bone pathology section of the pathologic anatomy Institute in the Central University of Venezuela.The tissues were processed and by the histopathologic analysis and the immunohistochemical study, the diagnosis of MNTI was done in both cases. Results:The morphology of both tumors showed small round cells and large, pigmented epithelial cells.The immunohistochemical study showed positive expression for NSE in the round small cells component of both tumors.HMB45 and CKAE1-AE3 were positive in the epithelial component. Conclusion:Regardless of whether most MNTI cases can show a benign course, its clinical, radiological, and histopathological characteristics mimic a malignant tumor.Given the rarity of these lesions, a deep understanding of the tumor by pediatricians, dentists, radiologists, and pathologists is needed to avoid unnecessary therapies.Immunohistochemical study is a valuable tool for diagnosing this tumor.
Background: Tonsillectomy is commonly performed otolaryngological operation.It can cause considerable pain in children.Different types of tonsillectomy are described in the literature.Modified technique of bipolar tonsillectomy can significantly reduce postoperative pain.Objective: This study aimed to assess postoperative pain in children after modified bipolar tonsillectomy.Methods: 120 patients, age 6-12 years, were selected for this study.Indication for tonsillectomy was a history of recurrent tonsillitis.Spetzler-Malis bipolar forceps (tip size 0.5 mm) with low energy (5 W) was applied.We tried to preserve the pillars as much as possible.Pain was assessed on 1st, 3rd, 5th, 7th and 10th postoperative days.The pain was evaluated with visual analogue scale (VAS).Results: On the first day of the operation 114 patients (95%) had no pain, 6 patients (5%) had mild pain, on the third postoperative day in 95% pain was mild, in 5% pain was moderate, on the fifth postoperative day pain was mild in 84 patients (70%), 36 patients (30%) had moderate pain, on the seventh postoperative day 95% of patients did not present pain, 5% of patients had mild pain.On the tenth postoperative day no one had pain.None of them presented nausea, vomiting, otalgia or severe pain. Conclusion:Low energy electrocautery, direct cautery to the tonsillar bed and preservation of the mucosa are all effective measures that have diminished post-op pain in bipolar dissection.
Background: Anaphylaxis represents the most immediate severe allergic reaction, and the need for early symptom recognition has led to the compilation of different clinical classifications. The objective of review:We aimed to create a completed and easy-usable anaphylaxis severity assessment tool that includes some warning signs for disease severity and helps allergists and emergency caregivers in disease management. Discussion:The overall severity either is defined by the highest numerical value of clinical symptoms.This instrument considers severe hypotensive events lacking skin symptoms after exposure to culprit allergen(s) more severe cases than identical reactions with skin symptoms.The abrupt hypotension may lead to failure of fluid extravasation and lack of mediators' concentration outside the cardiovascular system.The instrument also considers neurological symptoms and cardio/ cerebrovascular disease risk factors for ineffective initial treatment, complications, and a warning signal to ask for intensive care unit personnel to assist the treatment team.Independently to cardiorespiratory symptoms, an evidenced short(er) time interval between allergen exposure and the successive reaction (compared to previous episodes) is considered an indicator for the subject's observation in the red area of the emergency unit because the clinical situation may worsen suddenly. Conclusions:The potential incorporation of this instrument in the future severity assessment systems may help specialized caregivers recognize supplemental warning signals that account for possible disease worsening or complications and, therefore, allow them to avoid unnecessary fatal outcomes.
Background: Tracheostomies are commonly performed procedures. Risk of transmission of Covid-19 is considered high during formation of surgical tracheostomy and in the post-operative period, creating a significant clinical challenge. Aims/objectives: To identify areas of improvement for patients with tracheostomies and assess the impact of the Covid-19 pandemic on the rate of tracheostomy insertion. Materials and methods: Patients who underwent a tracheostomy in 2020 in a single tertiary referral centre were prospectively identified. Results: During the five-month period 61 tracheostomies were performed. The most common indication was prolonged mechanical ventilation (68.8% n=42), followed by prophylactic airway management (27.8% n=17) and emergency airway management (3.2% n=2). Four tracheostomies were performed in patients who tested positive for Covid-19, all were percutaneous. Three procedure-related complications occurred, all involving minor bleeding. Following tracheostomy 27.8% of patients were cared for only in ICU, 19.6% were cared for on a ward familiar with tracheostomy care and 39.3% were cared for on a general ward. This data was not available for 13%. Over the same 5-month period in 2019 a total of 79 tracheostomies were performed, 29% percutaneous and 71% surgical. Conclusions and significance: Surgical tracheostomy is an essential procedure in the management of a variety of patients.
