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Scopul lucrării. Studierea fiecărui tip de afecţiune inflamatorie rinosinusală, cu trecerea în revistă a tratamentului medical şi a procedeelor chirurgicale utilizate. Obiectivul lucrării. Codificarea indicaţiilor chirurgicale cu stabilirea beneficiilor şi limitelor fiecărui procedeu chirurgical (clasic sau endoscopic). Material şi metodă. Lotul studiat a fost compus din pacienţii cu afecţiuni rinosmusale internaţi în Clinica ORL a Spitalului Clinic Judeţean de Urgenţă Craiova între anii 2005 şi 2014, reprezentând 43,72% din totalul internărilor. Rezultate. A predominat patologia inflamatorie rinosinusală în proporţie de 56,74% (inflamaţii acute 14,94%, inflamaţii cronice 41,80% şi complicaţii ale rinosinuzitelor 2,47%). Concluzii. Afectarea inflamatorie a foselor'nazale şi sinusurilor paranazale include o patologie amplă, care solicită o examinare minuţioasă, clinică şi paraclinică, pentru obţinerea unui management terapeutic eficient. [ABSTRACT FROM AUTHOR]

Scop. Evaluarea participării componentei imune în procesele de remaniere la nivelul mucoasei rinosinusale interesate de procesul infecţios cronic de etiologie bacteriană. Material şi metodă. Studiul nostru s-a desfăşurat în SCJU Craiova pe o perioada de 3 ani şi a inclus 856 de pacienţi' diagnosticaţi cu rinosinuzită cronică bacteriană. 324 dintre aceştia au fost supuşi cel puţin unei intervenţii chirurgicale, obţinându- se fragmente de mucoasa sinusală, ce au fost prelucrate în nistologia clasică şi tehnici imunohistochimice pentru evidenţierea componentelor celulare imune, implicate în răspunsul inflamator local, precum şi a fenomenelor de remaniere prin evaluarea componentei angiogenetice. Am folosit markerii CD20, CD3, CD68 şi CD34 pentru evidenţierea limfocitelor B, T, macrofagelor, respectiv a celulelor endoteliale. Rezultat. Limfocitele B au avut o distribuţie neomogenă în infiltratul inflamator, fiind mai abundente perivascular şi în zonele de eroziune epitelială. Uneori, infiltratul inflamator a avut tendinţă de organizare foliculară, zone în care limfocitele B au fost mai abundente în zona centrală a acestor structuri. Limfocitele T au apărut a fi mai abundente decât limfocitele B, cu localizare preponderentă subepitelial şi perivascular. Macrofagele au fost identificate atât în epiteliul de acoperire, cât şi subepitelial. în ceea ce priveşte procesul de angiogeneză, tehnicile de imunohistochimie au evidenţiat existenţa unui număr mult mai mare de vase sanguine tinere. Concluzii. Reacţia inflamatorie este o reacţie de apărare complexă, care include atât fenomene alterative, cât şi fenomene reacţionale, vasculo-exsudative, proliferative şi reparatorii ineficiente. în aceste cazuri avansate, neglijate, rezecţia completă de mucoasă sinusală pare a fi singura soluţie viabilă. [ABSTRACT FROM AUTHOR]

Introducere. Simptomatologia clinică în cancerul de amigdală palatină a fost ştearsă şi confundată în primele stadii ale afecţiunii cu o simptomatologie de tip inflamator, motiv pentru care majoritatea pacienţilor s-au prezentat tardiv la medic, în stadiile III şi IV, conform clasificării TNM. Acuzele subiective au fost de tipul disfagiei şi odinofagiei unilaterale, otalgie reflexă, expectoraţii serosanghinolente, scădere ponderală marcată, halenă fetidă şi tulburări fonatorii de tipul stomatolaliei. Material şi metodă. Studiul s-a efectuat pe 132 de cazuri de tumori maligne amigdaliene (98,2% carcinoame scuamoase şi 1,8% limfoame), diagnosticate în clinica ORL prin biopsie excizională la Spitalul Clinic Judeţean de Urgenţă Craiova, între anii 2010 şi 2014. Piesele prelevate au fost supuse prelucrării în tehnici histologice clasice, respectiv imunohistochimice, utilizând ca markeri de proliferare celulară ate PCNA şi p53. Rezultate. Studiul histologic a evidenţiat faptul că numai 10% au fost carcinoame scuamoase bine diferenţiate, 37,27% carcinoame moderat diferenţiate, iar 52,7% slab diferenţiate. Carcinoamele epidermoide bine diferenţiate au apărut ca fiind formate din celule de aspect epitelial, poliedrice, joncţionate între ele prin desmozomi, amintind de celulele epiteliale ale stratului spinos. Celulele neoplazice au prezentat dimensiuni variate, cu nudei mari, cu inversarea raportului nucleu/citoplasmă. Nucleii celulelor carcinomatoase au apărut cel mai adesea hipercromi, cu contur neregulat, cu invaginări, lobulări sau înmuguriri nucleare, cu cromatină dispusă inegal, determinând astfel o coloraţie neomogenă a nucleului. Frecvent s-au înregistrat monstruozităţi nucleare sau celule poliploide. Nucleii au apărut cel mai adesea voluminoşi, multipli, bine evidenţiaţi. Frecvent s-a observat mitoze atipice, asimetrice, bipolare sau chiar'tripolare. Variaţiile celulare şi nucleare au determinat un aspect pleomorf al parenchimului tumoral, celulele superficiale carcinomatoase formând adesea perle cheratozice. Studiul imunohistochimic al factorilor de proliferare celulară PCNA şi p53 a arătat o imunomarcare intensă a celulelor din stratul profund şi absenţa imunomarcajului în perlele cheratozice. Imunocolorarea cu PCNA a marcat neuniform celulele carcinomatoase, inclusiv pe cele cu nudei monstruoşi, dovedind că acestea se găsesc în diverse stadii ale ciclului celular. Concluzii. Carcinoamele epidermoide bine diferenţiate au reprezentat doar 10% din studiul cancerelor de amigdală palatină. Parenchimul tumoral s-a caracterizat prin variat pleomorfism celular şi nuclear. Imunomarcarea PCNA şi p53 a fost intens pozitivă în celulele tumorale, inclusivîn celulele cu nudei monstruoşi, dovedind capacitatea proliferativă mare a celulelor carcinomatoase. [ABSTRACT FROM AUTHOR]

Introducere. Cancerul cavităţii orale este una dintre cele mai frecvente forme de neoplazie la nivel mondial (incidenţa 40/100.000 locuitori), fiind considerat o cauză majoră de morbiditate în întreaga lume. Justificarea studiului. Angiogeneza tumorală reprezintă procesul de construcţie de noi vase de sânge, pornind de la vasele de sânge existente în mod normal în ţesuturi, cu formarea unor reţele vasculare particulare, ce permit atât creşterea, cât şi diseminarea celulelor neoplazice în alte medii, aspect puţin studiat în carcinoamele orale. Material şi metodă. Pentru evidenţierea adecvată a proceselor de angiogeneza şi limfangiogeneză am utilizat tehnici de imunohistochimie, cu folosirea unor marked specifici pentru celulele endoteliale tinere. Studiul s-a derulat pe un număr de 34 de cazuri tratate în clinicile ORL, respectiv Chirurgie OMF - SCJU Craiova, în cursul anului 2014. Rezultate. în carcinoamele orale bine si moderat diferenţiate, vasele de angiogeneză au apărut dispuse preponderent în jurul insulelor sau cordoanelor de celule tumorale, la „frontul de invazie tumorală" si în stroma tumorală puternic infiltrată cu celule de tip imun. Evaluarea densităţii microvasculare a arătat că există diferenţe semnificative între numărul vaselor de angiogeneză şi gradul de diferenţiere tumorală. Ariile vasculare, de asemenea, au fost variabile în funcţie de gradul de diferenţiere al carcinomului: în carcinomul slab diferenţiat, aria vasculară a fost de circa două ori mai mare decât în carcinomul moderat diferenţiat şi de circa 4 ori faţă de carcinomul bine diferenţiat. Carcinoamele slab diferenţiate au prezentat un număr mult mai mare de capilare de angiogeneză şi lumen vascular mărit, ceea ce explică rata mai mare de metastazare a acestora. în carcinoamele bine diferenţiate, numărul vaselor limfatice a apărut redus, dispuse în imediata vecinătate a insulelor de celule tumorale. In schimb, la majoritatea cazurilor de carcinoame slab diferenţiate s-a observat prezenţa unui număr crescut de vase limfatice, unele de calibru mărit uneori cu celule tumorale în lumen. Concluzii. Considerăm că procesele de angiogeneză şi limfangiogeneză sunt esenţiale pentru dezvoltarea tumorală şi metastazare în carcinoamele orale. Aspectele constatate oferă un punct de plecare pentru studiul eficienţei inhibitorilor de angiogeneză în terapia acestor neoplazii. [ABSTRACT FROM AUTHOR]

Introducere. Analiza histologică şi imunohistochimică a unor tipuri de neoplazii amigdaliene şi a momentului stadial de prezentare. Material şi metodă. Prezenta lucrare este un studiu retrospectiv pe 6 ani (2008-2013) ce cuprinde 64 de cazuri diagnosticate prin biopsie excizională în Clinica ORL Craiova, fragmentele bioptice recoltate fiind prelucrate utilizând tehnici histologice clasice şi tehnica imunohistochimică LSAB pentru evidenţierea markerilor tumorali CD20 (LyB), CD45RO(LyT) şi a indicelui de proliferare nucleară PCNA. Rezultate. Macroscopic, tumorile au fost exofitice, ulcerative, infiltrative; tipul de carcinom epidermoid spinocelular slab diferenţiat, ulcerat invaziv, reprezentând aproximativ 40% din cazuri. Microscopic, carcinoamele epidermoide au avut arhitectură cordonală sau trabeculară, cu frecvente mitoze atipice şi monstruozităţi nucleare, cu nudei de aspect polipoid, hipertrofici, hipocromi, deformaţi, având multipli nucleoli evidenţi. Ţesutul limfoid a fost fie indemn, fie sediul unei reacţii fibroinflamatorii stromale în care am evidenţiat imunohistochimic prezenţa unei populaţii limfocitare numeroase, formată preponderent din limfocite T şi o cantitate mai mică de limfocite B, ceea ce ne face să credem că în stroma tumorală domină mecanismele de apărare celulară, în ceea ce priveşte indicele de proliferare nucleară PCNA, am remarcat faptul că intensitatea reacţiei imunohistochimice a fost variată, în funcţie de gradul de diferenţiere. Carcinoamele epidermoide necheratinizate slab diferenţiate au avut o extindere submucoasă şi o vascularizaţie mai abundentă, ceea ce a permis o metastazare precoce la distanţă. Carcinoamele epidermoide bine diferenţiate de tip keratinizat, în studiul nostru, au apărut cu numeroase perle kerâtozice, cu puţine prelungiri în stroma subiacentă, confirmând ipoteza că acestea sunt mai puţin metastazante. Concluzii. Carcinoamele amigdalei palatine, cu o incidenţă maximă la bărbaţii peste 50 de ani (85% din cazuri), reprezintă de departe cele mai frecvente tumori maligne localizate la acest nivel, fiind rar precedate de leziuni leucoplazice sau kerâtozice. [ABSTRACT FROM AUTHOR]

Introducere. Tromboza şi tromboflebita sinusului venos lateral (TSL) reprezintă complicaţiile unui proces supurativ otic sau otomastoidian. Sunt întâlnite în situaţiile de infecţie acută, dar predomină în cazurile de otomastoidită cronică. Incidenţa şi mortalitatea au scăzut drastic în urma apariţiei antibioterapiei. Material şi metodă. Studiul retrospectiv a fost efectuat pe o perioadă de 10*ani (2004-2013) în Clinica ORL Craiova şi a cuprins toţi pacienţii diagnosticaţi cu tromboză sau tromboflebită de sinus venos lateral. Rezultate. Âu fost identificate 10 cazuri cu TSL secundare otomastoiditei cronice şi două secundare otomastoiditei acute. Cele mai frecvente simptome’au fost otoreea şi febra. Evaluarea pacienţilor a presupus efectuarea preoperatorie a tomografiei computerizate pentru confirmarea diagnosticului. Majoritatea pacienţilor au avut complicaţii multiple supurative. La toate cazurile s-a practicat mastoidectomie radicală, cu excluderea sinusului venos interesat şi ligatura jugularei interne. Bacilii gram-negativi au fost cel mai frecvent depistaţi la examenul bacteriologic. Concluzii. Deşi este o complicaţie rară a otomastoiditei, este însoţită frecvent de alte complicaţii intrâcraniene. Tratamentul trombozei de sinus venos lateral este controversat, mastoidectomia radicală cu excluderea sinusului a permis vindecarea tuturor pacienţilor. [ABSTRACT FROM AUTHOR]

Copyright of ORL.ro is the property of MEDICHUB MEDIA, S.R.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of ORL.ro is the property of MEDICHUB MEDIA, S.R.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of ORL.ro is the property of MEDICHUB MEDIA, S.R.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of ORL.ro is the property of MEDICHUB MEDIA, S.R.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Pneumoniile infecţioase sunt produse cel mai frecvent de virusuri şi bacterii, la copil etiologia fiind dominată de infecţiile virale, care reprezintă până la 90% din toate pneumoniile copilului. Prezenta lucrare este rezultatul unui studiu retrospectiv efectuat pe un lot de 165 de sugari cu pneumonie acută care au fost internaţi în Clinica de Pediatrie a Spitalului Filantropia din Craiova în perioada 1 ianuarie-1 iulie 2010, în care ne-am propus să urmărim frecvenţa şi tendinţa actuală de evoluţie a pneumoniei acute la sugar, precum şi factorii de risc ce duc la instalarea tulburărilor respiratorii. Pneumoniile acute la cazurile studiate s-au vindecat fără sechele, atâtformele grave, cât şi cele cu evoluţie prelungită. Formele cu spitalizare de peste 10 zile au necesitat investigaţii suplimentare pentru excuderea unor complicaţii, afecţiuni sau accidente. La aceste cazuri evoluţia prelungită a fost corelată cu particularităţile legate de vârstă şi terenul imunodeficitar (distrofici, rahitici) după ce s-au exclus alte cauze. [ABSTRACT FROM AUTHOR]

Multiple primary cancers are usually defined as primary malignant tumors of different histological origins in one person. Synchronous cancers are defined as two or more primary cancers diagnosed in the same patient at the same time or within six months after identifying the first tumor, and those cancers that develop at more than a six-month interval are termed as metachronous multiple primary cancers. Our study comprised of a patient with synchronous laryngeal cancer with double localizations. The case was solved through surgical excision of the tumors. Histopathological and immunohistochemistry examinations revealed synchronous laryngeal cancer. Laryngeal cancer should usually be managed through surgical resection, followed by oncological treatment.

Aim: Laryngeal cancers are redoubtable because they are still diagnosed in advanced stages which results in poor survival and the decline of life quality. The authors intend to identify if the tumor topography influences clinical behavior, the morphological profile and therapeutic strategy., Patients, Materials and Methods: The study group included 188 patients with laryngeal malignancies diagnosed and treated in an Ear, Nose and Throat (ENT) Department. The patients have been divided into four groups according to the tumor topography and extension. Three categories of parameters were defined (epidemiological, clinical, and morphological) and analyzed comparatively between the four groups using filter scales and the χ² (chi-squared) correlation test., Results: Epidemiological parameters (sex, age, socio-economic status) showed no significant differences between the four groups. Clinical parameters (symptoms, lymphadenopathies, surgical procedures, and hospitalization) instead registered significant differences between the four groups. Morphological parameters (longitudinal diameter, transverse diameter, shape, gross aspect, histopathological aspect, grade, local invasion - pT, lymph node invasion - pN, metastases - pM and tumor stage), excepting shape, registered too significant differences between the four groups. The analysis of the whole set of parameters in each group revealed different, distinct profiles for each of the topographic groups, especially for glottic and large tumors. Our results concerning the entire series of tumors ranged in the limits of variation of each of the parameters observed in the literature., Conclusions: Our study revealed that tumors placed in different regions of the larynx have distinct profiles from epidemiological, clinical, and morphological points of view. However, the profile of our entire group of tumors proved to be comparable with the literature data.

Chronic palatal and nasopharyngeal inflammations are common lesions in pediatric pathology, with major effects on children's development. The study included 34 cases of chronic tonsillitis and adenoiditis for which we quantified immunohistochemically and analyzed the distribution of inflammatory elements in the follicular, extrafollicular and epithelial compartments, in relation to the composite histological scores and the clinico-epidemiological profile of the lesions. The cases were more frequent under the age of 10, in female patients, coming from urban areas, with the diagnosis of tonsillitis. B-lymphocytes have been associated with follicular areas in tonsillitis and epithelial areas in adenoiditis. In all compartments, T-lymphocytes were more frequently associated with tonsillitis and plasma cells associated with adenoiditis. Macrophages and dendritic cells had a relatively uniform distribution for the three compartments in all cases. The results obtained indicate different inflammatory phenotypes for chronic tonsillitis and adenoiditis, an aspect that may be useful for stratifying patients for optimal therapy.

Inflammation plays an important role in the pathogenesis of nasal polyps. Understanding the biomolecular action mechanisms of inflammatory elements can contribute to improving the prognosis of these lesions. The study analyzed the distribution and immunohistochemically quantified eosinophils [eosinophil major basic protein (BMK-13)], lymphocytes [cluster of differentiation (CD) 4, CD8, CD20] and plasmocytes (CD138) in both the epithelial and stromal compartment in relation to composite scores, which included specific histopathological parameters for 50 sinonasal polyps. Inflammatory elements predominated at stromal level, the high histological composite scores being frequently associated with increased expression of inflammatory elements. Also, the numerical distribution of inflammatory elements indicated positive linear relations within the groups BMK-13∕CD8 and CD4∕CD20∕CD138, and a negative linear relation between the two groups. This aspect can support the existence of alternative or sequential pathogenic mechanisms involved in the pathogenesis of sinonasal polyps, and the results obtained can be used for a better stratification of patients in order to optimize the therapy.

Chondrosarcoma is a malignancy of the mesenchymal tissue derived from transformed cells that produce the cartilage matrix. In the neck area, it represents less than 0.5% of malignant tumor pathology. Chondrosarcoma of the hyoid bone is extremely rare, only 20 cases having been published so far (PubMed 2014). We present the case of a 30-year-old patient from the urban area, admitted in the ENT (Ear, Nose & Throat) Emergency Service with inspiratory dyspnea, dysphagia, stomatolalia, with evolutive and progressive clinical history of 2-3 months. Endoscopic examination revealed a pharyngolaryngeal tumor process located in the right vallecula, who by mass effect displaces the above-hyoid epiglottis. CT (computerized tomography) scan described a cervical polycystic tumor aspect, with multiple septae and inside calcifications with a diameter of 3-4 mm. Surgery consisted in removal of the tumor process together with the hyoid bone. Histopathological and especially immunohistochemical examination established the diagnosis of low-grade chondrosarcoma of the hyoid bone. For assessment of the phenotype of the tumor cells, the following immunohistochemical markers were used: p53, Ki67. The patient followed radiochemotherapic oncological treatment and returned for regular follow-ups. There was a positive development with no signs of regional or remote relapse or metastasis for 24 months after surgical treatment. Surgery is the treatment of choice, with complete removal of the tumor, with chemoradiation playing an adjuvant role. Regular tracking of the patient is mandatory.

Squamous cell tonsil carcinoma is the most frequent form of oropharyngeal cancer, representing 70-80% of the total of head and neck malignant tumors. Poor clinical symptoms make that 60-80% of patients with squamous cell tonsil carcinoma have a late diagnosis, in the third and fourth stages, when the tumor exceeds the organ limits, invading the pharyngeal wall or the tongue base, being associated with metastases in the laterocervical lymphatic ganglions. The tumor necrosis factor alpha (TNF-α) represents an important inflammation mediator associated to carcinogenesis and even to tumor progression. We evaluated the seric values of TNF-α in a group of patients with tonsil cancer in comparison to a group of patients with chronic tonsillitis, as well as the reaction of mastocytes and macrophages in the two types of tonsil lesions. Seric levels of TNF-α in squamous cell tonsil carcinoma were quite high, varying from 1000 to 2000 pg÷mL, and in four patients, with poorly differentiated tonsil carcinoma in the fourth stage, the TNF-α values varied from 2000 to 4000 pg÷mL. In the patients undergoing radiotherapy, the TNF-α seric levels were within normal limits. In chronic tonsillitis, the TNF-α seric level varied from 10 to 200 pg÷mL. There were not observed any significant differences between the two types of tonsil lesions, regarding the macrophages and mast cells density on the surface unit.

Oropharyngeal cancer, and especially squamous cell carcinoma, is one of the most common cancers worldwide, and its incidence is increasing, with the palatine tonsil being one of the main locations. The etiopathogenic factors, together with its location as well as the available immunohistochemical methods, make this type of cancer an accessible one in terms of diagnosis. However, it is usually diagnosed in late stages. Therefore, we tried to elucidate the causes of treatment failures and development of local recurrence. For this, we reassessed the proliferative pattern of tonsil lesions using the anti-p53, anti-PCNA and anti-Ki67 antibodies on 73 tonsil fragments collected after curative surgery on adults aged between 28 and 86 years. Following the reevaluation of the histopathological examination using markers for cell proliferation, the diagnosis was modified in 16 cases, representing about 22% of the cases take into study. By using immunohistochemical markers in the histopathological examination the diagnosis is improved, leading to a more appropriate therapeutical approach.

We investigated the expression of cytokeratins 7 (CK7) and 20 (CK20) in nasal polyps on a group of 106 patients with chronic rhinosinusitis with nasal polyposis (45 women - 42% and 61 men - 58%) who benefited from surgical procedures. Harvested biological material was analyzed in the pathology laboratory through two methods: histopathological and immunohistochemical analysis. Classical histopathological method of processing the tissues initially fixed in 10% formalin was used. The tissues were then processed by paraffin impregnation, sectioned and stained with Hematoxylin-Eosin. The immunohistochemical method was based on soluble immunoenzymatic complexes - LSAB/HRP (labeled Streptavidin Biotin) method. We used DAKO LSAB 2 System HRP (Universal DAKO Labeled Streptavidin Biotin 2 System Horseradish Peroxidase). The expressions of CK7 and CK20 in nasal polyps were analyzed.

Objective: To study the anatomy of the posterior tympanic wall and to describe the four recesses (Sinus Tympani-ST, Lateral Tympanic Sinus-LTS, Posterior Tympanic Sinus-PTS, Facial Recess-FR) with their variations in shape, dimension, internal configuration., Material and Methods: Thirty-seven cadaver temporal bones were examined through the anterior dissection approach. The opening was enlarged by drilling to allow a good microscopic or rigid endoscopic view to the retro-tympanum. Measurements of the recesses were made with gradually millimeter wire, dial micrometric indicator (comparator clock), various right angled picks and sometimes by means of cast-impression--used in stomatology for dental impression (interior configuration)., Results: Out of 37 specimens, we have found PTS in 64.86% (24 cases), ST in 94.59% (35 cases), and LTS in 59.45% (22 cases). For FR, we have found four types. The most constant cell, located in the inferior external part of FR and in the same time, the biggest one was suprapyramidal Sappey's fossa, which we have found in 75.67% (28 cases) of all specimens. Sinus entrance of each recess was very variable, but in the most cases, we have found that the long diameter of ST and LTS was usually directed vertically and of PTS usually horizontally. The deeper recess was ST-2.74 mm (range 0.5 to 6.2 mm). Pyramidal eminence was visualized in 100% of cases, the pyramidal ridge in 89.18%, the chordal ridge in 78.37%, the suprapyramidal ridge in 35.13%, ponticulus in 83.78% and subiculum in 75.67%. In many cases, the inner configuration of each sinus was irregular, presenting either small recesses (0.2 to 1 mm) under the bone borders at the entrance in the sinuses or communication between the two sinuses., Conclusions: Presence of the all four recess is not a rule. Marked variation in the size and shape and especially in the internal configuration of all recesses is a rule. All recesses of the retro-tympanum can be recognized more easily, if we identify at first all elements of positive projection (pyramidal eminence, chordal ridge, styloid eminence, styloid ridge, pyramidal ridge, suprapyramidal ridge, ponticulus, subiculum).

Introduction: Malignant fibrous histiocytoma (MFH) is a tumor which has a mesenchymal origin, and an uncertain histogenesis. MFH with giant cell accounts for 3-15% of all malignant fibrous histiocytomas., Objective: To explore the histopathology, the diagnosis and the treatment of MFH with giant cell of larynx., Patient and Methods: We report a case of a glottic MFH at a 59-year-old male, who has been smoking for 30 years, and was hospitalized in June 2008 at Emergency County Hospital of Craiova., Results: The largely-sized tumor was originated in glottic area, upper a left vocal cord, with no paresis. The tumor determined respiratory failure and dysphonia. Patient underwent surgical excision of the tumor after an emergency tracheotomy. The immunohistochemical techniques proved positive for vimentin, smooth muscle actin, CD68, CD34, bcl2, EGFR, S100, Ki67, and negative for CD117, NFT, chromogranin, c-erbB2, CK34betaE12, MNF116, and p53., Conclusions: Malignant fibrous histiocytomas (MFH) with giant cell of larynx are very rare mesenchymal neoplasm (this case seems the first reported). The diagnosis of MFH of larynx was difficult and the immunohistochemistry could have been helpful.

We aimed to establish correlations between the clinical manifestations and histopathological changes occurring in otomastoiditis. To this effect, we have made a retrospective clinical and statistical study on a number of 146 patients diagnosed with otomastoiditis, admitted in the Otorhinolaryngology Clinic of the Emergency County Hospital, Craiova, during 2003-2007. Of the 146 patients, 128 (87.67%) were suggested to follow a radical surgical treatment (total petromastoidian evidation), in 10 cases (6.85%) a partial petromastoidian evidation was performed, and in eight cases (5.48%) there were made reappraisals of the petromastoidian evidation cavities. When the surgical procedures were performed, there were collected fragments of mucous from the middle ear or from the mastoid cavities, which were sent for examination to the Laboratory of Anatomical Pathology, where there were performed classical histological (Hematoxylin-Eosin and trichromic Van Gieson) and immunohistochemistry staining. The clinical and statistical study emphasized the fact that the onset of the disease was chronic in 143 patients (97.95%) and of acute type in three patients (2.05%). Taking into account the medical history of the patients, repeated episodes and incorrectly treated of acute infections of the middle ear (otitis) were found in most cases, amounting to a percentage of 97.95%. The distribution of the patients on the five years was relatively uniform, in 2003 - 24 cases (16%), in 2004 - 36 cases (25%), in 2005 - 28 cases (19%), in 2006 - 25 cases (17%), in 2007 - 33 cases (23%), and the most affected age groups were 21-30-year-old (19.86%) and 51-60-year-old (21.92%). Analyzing the cases included in the studied group emphasized the fact that for a relatively large percentage of patients (87.67%) it was required as an immediate necessity the surgical procedure of total petromastoidian evidation, due to the extensive damages, the negligence of the patients that did not contact in proper time a medical specialist. The most frequent histopathological diagnose was of cholesteatoma in 60 cases (41.10%), fact which also grounded the surgical procedure. Immunohistochemical and microscopic study highlighted in the epithelium areas of necrosis, associated with areas of reactive hypertrophy and hyperplasia, and in the chorion, the existence of a chronic inflammatory infiltrate made up of lymphocytes, plasmocytes and macrophages. The immunohistochemistry studies stressed the preponderant presence of T-lymphocytes and macrophages in the chorion of the mucous of the middle ear, confirming the presence of an immune reaction, predominantly of cellular type.

Objectives: Chronic tonsillitis represents the most common inflammatory lesions of the pharynx determining numerous local or distant evolutive complications. We decided to study the histological and especially immunohistochemical expression of this pathology., Material and Methods: We have studied 112 surgical samples representing tonsils resected from 56 patients with chronic tonsillitis. The tonsillectomies were performed in the ENT Clinic of the Emergency County Hospital of Craiova, between 01.01.2007--31.12.2007. The processed histological samples were stained using Hematoxylin-Eosin, light green trichromic and argental impregnation. For the immunohistochemical study, we used LSAB method with CD20, CD45 RO, CD68 antibodies in order to reveal and differentiate T- and B-lymphocytes and also the macrophages., Results: In all samples, we found hyperplasia and hypertrophy of the lymphoid follicle with excessive developing of the clear germinal center as a normal reaction to antigens presence. In some cases, we remarked micro hemorrhages and hematic extravasations inside the follicles, probably due to the excessive virulence of the pathogens causing endothelial lesions. The conjunctive stroma was enriched in collagen fibbers, in some cases organized in strong fascicles with an obvious tendency to divide the tonsils in lobules. The young fibroblastic type cells were numerous. The specific reticulin fibbers had a low representation being disorganized. The immunohistochemical study proved that the clear center of the lymphoid follicles was occupied by B-lymphocytes, but the T-lymphocytes were present in the cortical region of the follicles, perifollicles and in the surface epithelium., Conclusions: In some pathological cases, the predominant cellular population of the clear center was formed by T-lymphocytes.

A solved case of bilateral choanal atresia in a 10 hour newborn allowed the authors to make some pathogenic, clinic and therapeutic considerations. The paper underlines the high severity of the disease, which imposes the need of a quick diagnosis and an emergency surgical procedure assuring the airway patency and proper ventilation. The transnasal endoscopic approach is the procedure of choice, being quick, safe, providing direct and excellent visualization of the nasal cavity and posterior choanae, and having less postoperative morbidity than other surgical procedures. It is also emphasized the need of general anaesthesia with VIMA technique, which covers all the requirements of the anaesthesia in newborn.

Objective: We investigated the proliferative activities in premalignant laryngeal vocal chord lesions treated by epithelial stripping in microlaryngoscopy, using immunohistochemical staining with anti-p53, anti-PCNA and anti-Ki-67 monoclonal antibody and we correlated with clinic and morphologic aspects., Material and Methods: The study was made on 32 patients hospitalized in Craiova ENT Clinic in 2005 presenting lesions precursor to vocal cord malignity. The lesion's aspect was observed using suspended microlaryngoscopy, a biopsy was performed and biological tests were examined from a pathological and immunohistochemical point of view, with the investigation of the following immunohistochemical markers: Ki-67, PCNA and p53., Results: 13 cases (41%) presented red hypertrofic cronic laryngitis, seven cases (22%) presented white hypertrofic cronic laryngitis, and 12 cases (37%) presented papillomas with with simple, moderate, severe dysplasia and in situ carcinoma in 62.5%, 22%, 12.5% and, respectively, 3% of the cases. All the dysplasic lesions, no matter the dysplasic degree, have presented alteration of both surface eplitelium and chorion. The expression of Ki-67, PCNA and p53 was correlated with the dysplasia's degree in various proportions., Conclusions: In clinical practice, morphological grading of dysplasia is difficult to evaluate. The Ki-67 and PCNA markers were correlated with the dysplasia degree; the expression of p53 was present only in 28% cases with moderate dysplasia and in one case with in situ carcinoma.