Andjelka Stojkovic

The treatment of hemangioma of the larynx in children is still a dilemma

1 University of Kragujevac, Faculty of Medical Sciences, Department of Paediatrics, Kragujevac, Serbia; 2 Clinical Centre of Kragujevac, Pediatric Clinic, Kragujevac, Serbia; 3 Clinical Centre of Kragujevac, Department of Clinical Pharmacology, Kragujevac, Serbia; 4 Clinical Centre of Kragujevac, Clinic for Otorhinolaryngology, Kragujevac, Serbia; 5 Clinical Hospital Center, Department of Child Surgery, Kosovska Mitrovica, Serbia; 6 University of Kragujevac, Faculty of Medical Sciences, Department of Anatomy, Kragujevac, Serbia

Sneezing - a symptom of respiratory or psychogenic superposition of illness in a teenager?

Introduction. The coincidental combination of allergic respiratory diseases and psychogenic or psychiatric illness is possible but rarely associated in a female teenager. Case report. A girl aged 12.5 years was admitted to the Pediatrics Clinic in the Clinical Centre Kragujevac with the main difficulty of sneezing as 10 sneezes in each of the 500–600 series a day, only in the waking state. Working diagnoses were tic disorders associated with Allergic rhinitis, asthma and biochemically determined rickets. The patient was treated with chlorpromazine, desloratadine, montelukast, fluticasone propionate, vitamin D, azelastine hydrochloride along with the elimination diet. After a year and a half, the patient rarely sneezed, but periods without sneezing were not longer than 3 months, and she ‘cleared her throat’ occasionally. Although her clinical condition is less severe now and without additional motor tics or symptoms of Tourettes disorder, because of its length we suspect the tic turned into a chronic vocal tic disorder. Conclusion. We reported a case of rare association between allergic rhinitis and condition of tic-related conversion in a female teenager and emphasized the necessity of revising the systematisation for the tic disorders and protocol for the allergic rhinitis in terms of their association.

Treatment of subacute osteoporotic vertebral compression fractures with Percutaneous vertebroplasty: A case report

Introduction. Percutaneous vertebroplasty (PVP), as a mini-invasive approach in the treatment of patients with osteoporotic vertebral compression fractures (OVCFs), provides stabilization of the spine and relives pain. The most commonly it is applied in the 3–6 weeks before bending of the spine. Complete cessation of pain is easier to achieve if you treat “less mature” fractures. The aim of the report is to show that PVP is effective and safe for old fractures too. Case report. A 77-old patient suffered from a stable compression fracture of 3th lumbar (L3) vertebral body after minor trauma. This fracture was clinically and radiologically diagnosed. The conservative treatment that included lumbo-sacral orthosis (LSO), analgesic drugs and physical therapy, was primarily applied due to permanent pain and type of fracture. After a period of two months, pain persisted, but it was localized in a thoracic spinal segment with radiologically diagnosed fractured bodies of 8th (Th8) and 10th (Th10), thoracic vertebra without neurological deficit. Thoraco-lumbo-sacral orthosis (TLSO) was prescribed and after six months the indication for vertebroplasty of the Th8 and Th10 vertebral body was given. The pain relief had been achieved and the patient was discharged from the Clinic for Orthopedics on the postoperative day 2, and was symptom free during the follow-up period. Conclusion. In patients with stable OVCFs, PVP is an effective therapy for reducing pain and improving mobility of 6 months old fractures.

Is it Possible to Predict Mortality in Preterm Neonates, Based on a Single Troponin I Value at 24 h?

To the Editor: An early detection of post-asphyxia syndrome in preterm neonates is very difficult; especially when it is known that a low Apgar score (AS) is not always a consequence of perinatal asphyxia [1, 2]. There are insufficient number of studies, linking bad outcome of post-asphyxia with serum concentrations of cardiac troponins in neonates, and their values have not been precisely defined [3–5]. The experimental group in our study consisted of 45/70 male and 25/70 female preterm neonates; gestational age 31.7±3.36 wk; body weight 1849±699.09 g; 5-min AS 5 (5–7); lactate levels in the first 6 h after birth 5.5 (4.4-8.2) mmol/L. Primary resuscitation was required in 25/70, the use of inotropes in 34/70 and conventional mechanical ventilation in 51/70 patients. The outcome was fatal in 12/70. The control group consisted of 23/38 males and 15/38 females, gestational age 32.4±3.25 wk; body weight 1957± 687.45 g; 5-min AS 8 (8–8); lactate levels 0.9 (0.8–1.2) mmol/L. All patients only required basic intensive care (diffuse oxygen in the incubator FiO2<40 %). Cardiac troponin-I ultra (CTNU) values at 24 h were significantly higher in the experimental group: 0.02 (0.01–0.062) mcg/L, when compared to the control group: 0.01 (0.01–0.01), while CTNU values did not correlate significantly with serum lactate (r=0.191, p=0.121) and 5-min AS (r=0.05, p=0.683) (Table 1). Hypotensive patients had significantly higher levels of CTNU (median 0.04 mcg/L; 0.01 to 0.13 mg/L, p=0.009) compared to those without inotropic therapy (0.01 mcg/L; 0.01–0.037 mcg/L). CTNU was negatively correlated with ejection fraction (EF) of left ventricle [63.18 % (47.5– 74.11); r=−0.479; p=0.0005], while there was no significant difference between ventilated (respiratory distress was 62/70) and non-ventilated subjects (r=0.356). Increase of CTNU >0.045 mcg/L was a significant predictor of fatal outcomes [Confidence Interval 79 %; sensitivity 66.7 %; specificity 79.3 %; positive predictive value (PPV) 91.8%; negative predictive value (NPV) 38.1%], while 5-min AS <4.5was a less reliable predictor of mortality (p=0.024), if compared to lactate (p=0.004), and CTNU (p=0.002).