Medicina, Volume 49, Issue 11 (November 2013) – 6 articles

Amyloidosis is a rare condition characterized by the deposition of abnormal protein filaments into the extracellular tissue. Only 16 cases of true primary idiopathic amyloidosis local- ized in the nose and the paranasal sinuses have previously been reported. We present a case of local- ized amyloidosis involving the sinonasal cavities and the nose in a 53-year-old woman. Our patient was operated on as a typical case of chronic rhinosinusitis with polyps, but after 2 years, the patient came back with severe symptoms of nasal obstruction and pain in the frontal and maxillary regions with proptosis of both eyes. Magnetic resonance imaging revealed sinonasal-intraorbital masses. Primary amyloidosis (AL type) was confirmed by tissue biopsy. A systemic workup for additional amyloid deposits revealed no evidence of other diseases. Extended surgery produced a symptomatic improvement. Full article

Objective. The aim of the study was to determine whether the implementation of the quality system (QS) in primary healthcare made the care of chronically ill patients in family practice more consistent and reduced the load in specialized medical care.
Material and Methods. A quantitative retrospective cohort study using the database of the Es- tonian Health Insurance Fund was provided. Patients with diagnosed essential hypertension (HYP) and/or type 2 diabetes mellitus (DM2) formed the study group. If the family physician met the criteria for the monitoring of patients with DM2 and HYP set in the QS, the result was defined as positive. The number of disease-specific hospitalizations, the length of hospital stay, and the num- ber of visits to family physicians and medical specialists due to HYP or DM2 in 2005-2008 were evaluated.
Results. Chronically ill patients (DM2 and HYP) in the lists of family physicians with a posi- tive QS result were 1.26 times more likely (95% CI, 1.25-1.28) to be continuously monitored than those in the lists of family physicians with a negative QS result. The 2 coexisting chronic diseases (DM2 and HYP) increased the chance of being continuously monitored and increased the number of visits. The chance of being monitored by a medical specialist alone was reduced if the family phy- sician participated in the QS (OR, 0.66; 95% CI, 0.64-0.69) and had a rural practice (OR, 0.53; 95% CI, 0.51-0.55) and if the patient was a woman and older and had a diagnosis of HYP alone. The participation of family physicians in the QS reduced the hospitalization risk (OR, 0.9; 95% CI, 0.88-0.94) as well as the number of hospitalizations for the patients with HYP (OR, 0.93; 95% CI, 0.87-0.99).
Conclusions. The implementation of the QS in primary healthcare reduces the load in specialized medical care. A more detailed analysis of the effect of the QS on the workload and the organization of family practice as well as on the patients' morbidity and satisfaction could be done in the near future. Full article

Drug-induced acute pancreatitis is a rare condition in childhood, and information about the incidence of valproic acid-induced acute pancreatitis in the pediatric population is scarce. In this clinical case, we report a first documented pediatric case of valproic acid-induced pancreatitis in Estonia. A 15-year-old boy with juvenile myoclonic epilepsy developed acute pancreatitis after 2-month therapy with valproic acid. The symptoms of pancreatitis subsided within 1 week after the discontinuation of treatment with valproic acid. Acute pancreatitis should be suspected in any pedi- atric patient with gastrointestinal symptoms during valproate treatment Full article

Background and Objective. Malocclusion, the body posture, and the breathing pat- tern may correlate, but this issue is still controversial. The aim of the study was to examine the relationship between the type of malocclusion, the body posture, and the nasopharyngeal obstruction in 12-14-year-old children.
Material and Methods. The study group consisted of 76 orthodontic patients (35 boys, 41 girls) aged 12-14 years (mean age, 12.79 years {SD, 0.98J). All the patients were examined by the same orthodontist (study model and cephalometric radiograph analysis), the same orthopedic surgeon (body posture examined from the front, the side, and the back), and the same otorhinolaryngologist (anterior and posterior rhinoscopy and pharyngoscopy) in a blind manner.
Results. The prevalence of a poor body posture and a nasopharyngeal pathology was high in the present study. In total, 48.7% of the orthodontic patients had a kyphotic posture and 55.3% a rib hump in the thoracic region. The nasopharyngeal pathology was diagnosed in 78.9% of the patients. The patients with the kyphotic posture had a higher mandibular plane angle (MP-SN) and a lower sagittal position of the mandible SNB angle. A deeper overbite correlated with shoulder and scapular asymmetry. The kyphotic posture was diagnosed in 55.0% of the patients with the naso- pharyngeal pathology.
Conclusions. The sagittal body posture was related to the vertical craniofacial parameters and hypertrophy of the tonsils and/or the adenoids. The study showed no relationship between the degree of crowding, the presence of a posterior cross bite, orthopedic parameters, and a breathing pattern. Full article