Sarkoidóza patří mezi systémová granulomatózní onemocnění postihující hlavně plíce a lymfatický systém. Ve svých vzácných, akutních formách se může manifestovat jako tzv. Löfgrenův syndrom (kombinace erythema nodosum, oboustranné pulmonální hilové lymfadenopatie, bolestí kloubů, horečky a celkových příznaků) a ještě vzácněji jako Heerfordtův syndrom (kombinace horečky, přední uveitidy, oboustranného otoku parotické oblasti a jednostranné či oboustranné parézy lícního nervu). Přestože se jedná o raritní diagnózu, patří do diferenciální diagnostiky náhle vzniklé parézy lícního nervu a otoku parotické oblasti. V naší kazuistice popisujeme Heerfordtův syndrom u padesátileté ženy. Diskutována je patofyziologie, symptomatologie, diagnostika a léčba tohoto vzácného syndromu.
Sarcoidosis is a systemic granulomatous disease that mainly affects the pulmonary and lymphatic systems. In its rare, acute forms, it can manifest as Lofgren’s syndrome (combination of erythema nodosum, bilateral pulmonary hilar lymphadenopathy, joint pain, fever and general symptoms) and even more rarely as Heerfordt’s syndrome (combination of fever, anterior uveitis, bilateral edema of the parotid area and uni or bilateral facial nerve paresis). Although this diagnosis is rare, it belongs to the differential diagnosis of sudden paresis of the facial nerve and swelling of the parotic area. In our case report, we describe Heerfordt’s syndrome in a 50-year-old woman. The pathophysiology, symptomatology, diagnosis, and treatment of this rare syndrome are discussed.
- MeSH
- lidé středního věku MeSH
- lidé MeSH
- nervus facialis patologie MeSH
- paréza MeSH
- sarkoidóza * diagnóza komplikace terapie MeSH
- uveoparotická horečka * diagnóza etiologie terapie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
PURPOSE: Warthin tumour (WT) management options comprise surgery or follow-up. The purpose of this study was to asses our experience with the follow-up strategy in selected patients with an ultrasound-guided fine-needle aspiration biopsy (FNAB) showing WT. METHODS: We performed a retrospective analysis of patients diagnosed with WT using FNAB between 1.1.2006 and 31.12.2019. Patients were divided into three groups according to the therapeutic approach-immediate surgery, follow-up or surgery and follow-up. RESULTS: 323 patients were diagnosed with WT and met the study's inclusion criteria (154 women, 47.7% and 169 men, 52.3%). 192 patients were operated right after the diagnosis, 109 patients were observed with their first detected tumour and 22 patients had parotid WT surgery and were in the wait-and-scan protocol with a contralateral tumour, recurrence or both. The growth rate (GR) of observed WT was highly variable (mean GR 1.0 mm/year (5%), median GR 0.8 mm (9%), range - 19.7 to +20.0 mm/year). From 131 patients in the follow-up group, 19 patients underwent surgery and definitive histology revealed 17 WTs and 2 adenocarcinomas. However, these 2 patients had changes in sonographic findings at their next control. The mean observation time was 44.7 months (range 12-138 months) in patients followed exclusively at our institution and 50.9 months (range 12-110 months) in patients observed in cooperation with an otorhinolaryngologist at the patients' place of residence. CONCLUSION: Ultrasound-guided FNAB is an accurate and simple method in WT diagnosis and based on its result a follow-up strategy can be chosen for selected patients with WT.
- MeSH
- adenolymfom * diagnostické zobrazování patologie chirurgie MeSH
- intervenční ultrasonografie MeSH
- lidé MeSH
- následné studie MeSH
- retrospektivní studie MeSH
- senzitivita a specificita MeSH
- tenkojehlová biopsie metody MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
INTRODUCTION: The facial nerve surgery belongs to the basic procedures during lateral skull base approaches. Its damage has serious medical and psychological consequences, and therefore mastery of reconstruction and correction techniques should belong to the repertoire of skull base surgeons. The goal of this study was to demonstrate usefulness of electromyographic follow-up in facial nerve reconstruction. MATERIAL AND METHODS: A total of 16 patients underwent hemihypoglossal-facial anastomosis between 2005 and 2017. Most of the primary lesions came from vestibular schwannoma surgery. All patients were examined with electromyography and scored according to the House-Brackmann and IOWA grading scales. Function of the tongue has been evaluated. RESULTS: Ten patients achieved definitive House-Brackmann grade 3 score (62.5%). We did not observe any association with the patient's age, previous irradiation and the etiology of the damage. Electromyography showed pathological spontaneous activity after the first surgery. Incipient regeneration potentials were detected in 4-17 months (average 7.6) and reached maximum in 6.5-18 months (average 16). Electromyographic assessment of the effect of tongue movement showed better mimic voluntary activity by swallowing or by moving the tongue up. There was no relationship between the start of activity and the interval to achieving maximal activity. CONCLUSION: Hemihypoglossal-facial nerve anastomosis is a safe procedure and it is an optimal solution for cases lacking a proximal stump or in the case of reconstruction in the second stage. Electromyography can predict initial reinnervation activity after reconstructive procedures. During subsequent follow-up it can help to discover insufficiently recovering patients, however clinical characteristics are crucial.
- MeSH
- anastomóza chirurgická MeSH
- faciální paralýza * MeSH
- lidé MeSH
- nervus facialis * chirurgie MeSH
- nervus hypoglossus chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
