Professional Documents
Culture Documents
NICOLAE TESTEMIANU
CATEDRA OTORINOLARINGOLOGIE
ef catedr: Ion ABABII, academician al A..R.M, prof. univ.
ef clinica ORL: Alexandru SANDUL, d..m, prof. univ.
TEZA DE
DIPLOM
MENINGITA
OTOGEN ISTORIC I
ACTUALITI
Autor:
LUCIA BRUNCHI, anul VI, grupa1628
Coordonator tiinific:
ANDREI ANTOHI, conf. univ., d..m
STRUCTURA TEZEI
1
Introducere
CAPITOLUL I.
Fundamentele
teoretice ale
meningitei otogene
1.1. Delimitri
conceptuale despre
meningita otogen
1.2. Epidemiologia
meningitei otogene n
context internaional i
naional
1.3. Clasificarea i
caracteristica
meningitelor otogene
02
CAPITOLUL II.
Materiale i metode
folosite n studiu
2.1. Lotul de studiu
2.2. Prelucrarea
statistic i evaluarea
rezultatelor
CONCLUZII GENERALE
BIBLIOGRAFIE
3
CAPITOLUL III.
REZULTATE I
DISCUII ALE
STUDIULUI
3.1. Rezultatele
studiului
3.2. Discuii privind
studiul efectuat
SCOPUL CERCETRII
Determinarea
aspectelor
generale ale
meningitei
otogene
i elucidarea
de tratament
pacienilor cu
otogen.
metodelor
modern a
meningit
OBIECTIVE
Documentarea teoretic despre meningita
otogen
Analiza comparativ a datelor epidemiologice n
RM din sursele de specialitate
Studierea metodelor contemporane de diagnostic
i tratament a pacienilor cu meningit otogen
Stabilirea etiologiei, diagnosticului i tratamentului
meningitei otogene n baza studiului efectuat
Formularea concluziilor generale despre unele
aspecte ale meningitei otogene
este obiectivat de
determinarea metodelor
contemporane de diagnostic i
tratament utilizat n meningita
otogen.
SEMNIFICAIA
TEORETIC
VALOAREA
APLICATIV
- determinarea
conceptelor-cheie
despre MO
- introducerea n
practic a
modalitilor
eficiente de
diagnosticare i
tratare a pacienilor
cu meningit
EPIDEMIOLOGIE
ara
Numrul de CIO
Japonia
1,3%
Marea Britanie
1,6%
SUA
1,7%
Germania
1,7%
Frana
1,8%
Rusia
3,2%
Belarus
2,9%
Ucraina
3,3%
Moldova
3,1%
Incidena complicaiilor intracraniene otogene pentru anul
2007,
CLASIFICAREA MENINGITEI
OTOGENE
- Forma clinic
Meningita localizat
Circumscris
Seroas
De protecie
Meningism
Meningita generalizat
Difuz
Purulent
Leptomeningit
Formele izolate
Meningita (meningoencefalita )
Formele combinate
Meningoencefalita + tromboflebita
sinusului venos lateral (v. jugulare
interne)
Meningoencefalita + abces cerebral
Meningoencefalita + abces cerebelos
Meningoencefalita + tromboflebita
sinusului venos lateral + abces cerebelos
pe cile
preformate
(prin dehiscen),
pe unde trec
vasele ce unesc
sistemele nervos i
limfatic ale urechii
i ale cutiei
craniene
pe cile
hematogen i
limfogen
prin contact
sau pe cale de
continuitate
per
continuitatem
(distrucie
carioas a
osului)
Patogenia
MO
- cile de
propagare a
infeciei
calea labirintogen
prin conductul
auditiv intern, prin
apeductele
melcului (mai des)
i ale vestibulului
cale traumatic
-fractura bazei
craniului ce
trece prin
peretele
superior al
cavitii
timpanice
coincide cu o
inflamaie
purulent
Cefal
Cefal
ee
ee
Semne
Semne
piramipiramidale
dale
Grea
Grea
i
i
vrstu
vrstu
ri
ri de
de
tip
tip
central
central
Excitaie
Excitaie
psihomo
psihomo
-torie
-torie
Tabloul
clinic al
MO
SomnoSomnolen
len
Delir
Delir
Convulsi
Convulsi
ii
Semne
Semne
meningi
meningi
-ene
-ene
Febr
Febr
393940C
40C
Analiza LCR
Imagistica prin Rezonana
Magnetic
Computer Tomografia
PROFILAXIA
Monitorizarea i asanarea tuturor
focarelor de infecie otic otite
medii acute i cronice, n special
celor cronice supurate, care n 9395% preced o complicaie
intracranian otogen (OMAS 57%).
REZULTATE I DISCUII
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Nr. de
19
20
21
11
16
17
13
18
14
16
pacieni
18-30
31-40
41-50
51-60
61-70
Total
Brbai
21
Femei
17
Total
10
13
38
53 (32%3.63)
38 (23%3,28)
Abcesul extradural
Abcesul subdural
Abcesul cerebral
Abcesul cerebelos
Formele combinate
112 (68%3,63)
47
11
28
Abcese multiple
14
12
Repartizarea dup
gen
10
8
Nr. de pacieni
6
4
2
0
18-30
31-40
41-50
51-60
61-70
Vrsta, ani
Femei; 45%
Repartiia grafic
dup vrst
Brbai; 55%
Desinestttor
Serviciul de urgen
Din teritoriu
30
Mediul
Mediul de
de trai
trai
Rural
Rural 55%
55%
21
21 cazuri
cazuri
Urban
Urban 45%
45%
17
17 cazuri
cazuri
Femei
Femei 43%
43%
99 cazuri
cazuri
Femei
Femei 47%
47%
88 cazuri
cazuri
Brbai
Brbai 57%
57%
12
12 cazuri
cazuri
Brbai
Brbai 53%
53%
99 cazuri
cazuri
Modul de spitalizare
Cefaleea
Cefaleea
100%
100%
Semne
Semne
neurologice
neurologice
pozitive
pozitive
100%
100%
Vome
Vome 16%
16%
Febr
Febr 97%
97%
Meningit
a
otogen
Somnolen
Somnolen
16%
16%
Fotofobie
Fotofobie
26%
26%
Iritabilitate
Iritabilitate
78%
78%
Simptomatologia pacienilor cu MO
Etiologia MO
Anaerob
Viral
Bacterian
7% 5%
88%
ngroarea meningelui la CT
scanare
Imagine coronariana
nativ
Tratamentul chirurgical
Evidarea
Evidarea petro-mastoidian
petro-mastoidian
parial
cu
parial cu deschiderea
deschiderea fosei
fosei
craniene
medii
craniene medii
11
11 pacieni
pacieni
28,95%
Antromastoidotomia
Antromastoidotomia cu
cu
deschiderea
fosei
craniene
deschiderea fosei craniene
medii
medii
77 pacieni
pacieni
18,42%
18,42%
Evidarea
Evidarea petro-mastoidian
petro-mastoidian
total
total cu
cu deschiderea
deschiderea fosei
fosei
craniene
medii
i
posterioare.
craniene medii i posterioare.
20
20 pacieni
pacieni
52,63%
52,63%
Tratamentul
terapia bacterian
medicamentos
dezintoxicarea, corecia
echilibrului electronic i lichidarea acidozei
metabolice
combaterea edemului cerebral, lichidarea neurotoxicozei i a
sindromului
convulsiv
terapia stimulatoare, ameliorarea proceselor oxido-reductoare i a
metabolismului
CONCLUZII
CONCLUZII
BIBLIOGRAFIE
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
Alper CM, Bluestone CD, Casselbrant ML, Dohar JE, Mandel EM. Advanced therapy of otitis media. Hamilton-London: BC Decker; 2004. p. 374-8.
Andrews JC, Rinaldo RF. Otogenic Pneumocephalus. Laryngoscope 1986;96:521-8.[PubMed]
Barry B, Delattre J, Vi F, Bedos JP, Ghanno P. Otogenic intracranial infections in adults. Laryngoscope 1999;109:483-7.[PubMed]
Cadariu E., Otorinilaringologie (tratat) V. 1-2, Bucureti, 1964
Catedra otorinolaringologie, Institutul de Stat de medicin N. Testemianu, Complicaiile endocraniene otogene ndrumri metodice, Chiinu, 1990
Ceauu Gh., Urgenele ORL, Bucureti, 1966
Centers for Disease Control and Prevention. Meningococcal disease and college students: recommendations of the Advisory Committee on Immunization
Practices (ACIP).MMWRRecomm Rep. 2000;49(RR-7):1320.
Centers for Disease Control and Prevention. Revised recommendations of the Advisory Committee on Immunization Practices to Vaccinate all Persons
Aged 1118 Years with Meningococcal Conjugate Vaccine.MMWRMorb Mortal Wkly Rep.2007;56:794795.
Ciorba A., Berto A., Borgonzoni M., Grasso DL., Martini A., Pneumocephalus and meningitis as a complication of acute otitis media: case report,
Journal List, Acta Otorhinolaryngol Ital, v.27(2); Apr 2007, PMC2640004, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2640004/
Columbeanu Mandal, MD, DR, History of meningitis, http://www.news-medical.net/health/History-of-Meningitis-(Romanian).aspx
Courville C.B., Intracranial complication of otitis media and mastoiditis in the antibiotic era, Laryngoscope, 65:31, 1955
De Gans JD, van de Beek D. Dexamethazone in adults with bacterial meningitis. NEJM 2002;347:1549-56.[PubMed]
De Oliveira Penido N, Borin A, Iha LC, Suguri VM, Onishi E, Fukuda Y, et al. Intracranial complications of otitis media: 15 years of experience in 33
patients. Otolaryngol Head Neck Surg 2005;132:38-42.[PubMed]
Felisati G, Di Berardino F, Maccari A, Sambataro G., Rapid evolution of acute mastoiditis: three case reports of otogenic meningitis in adults. Am J
Otolaryngol 2004;25:442-6.[PubMed]
Fessler RD, Sobel J, Guyot L, Crane L, Vazquez J, Szuba MJ, et al. Management of elevated intracranial pressure in patients with cryptococcal
meningitis. J Acquir Immune Defic Syndr Hum Retrovirol 1998;17:137-42. [PubMed]
George E. Shambaugh, Jr., M.D., Michael E. Glasscock, III, M.D., Surgery of the ear, third edition, 1980, p. 289-313
Granoff DM, Harrison LH, Borrow R. Meningococcal vaccines. In: Plotkin SA, Orenstein WA, Offit PA, eds.Vaccines. 5th ed. Philadelphia, PA: Saunders
Elsevier; 2008:p399434.
Kangsanarak J, Fooanant S, Ruckphaopunt K, Navacharoen N, Teotrakul S. Extracranial and intracranial complications of suppurative otitis media:
report of 102 cases. J Laryngol Otol 1993;107:999-1004.[PubMed]
Harpman. J. A., On the management of otorrhinogenic intracranial infections. J. Laryng & Otol., 69:180, 1955
Hozne. A. L., and Riff, E. R., Terramycin therapy for meningitis; a report of 14 recoveries without other medication. J. Pediat., 39:151, 1951
Lane, W. A., Middle ear suppurations and their complications. Brit. M. J., 1:998, 1889
Lepper M.H., Dowling H.F., Management of pacient with meningitis, GP, 7:47, 1953
Nager G.T., Pathology of the temporal bone. Baltimore: Williams and Wilkins; 1993. p. 262-3.
Paparella M., Marcos V. Goycoolea, Timothy T. K. Jung, Section 3: Diseases of the Ear, Part 3: Middle Ear and Mastoid,Chapter 31:Complications of
Suppurative Otitis Media, http://sigmamax.tripod.com/ent/paparella/pap0231.pdf
Punescu C., Otorinolaringologie pediatric, Bucureti, 1972
Punescu C., Otorinolaringologie pediatric, Bucureti, 1984
Plotkin S.A., Mortimer E.,Vaccines, New York: Harper Perennial; 1988.
Plotkin S.A., Orenstein WA, Offit PA, eds.Vaccines. Philadelphia: Saunders; 2008.
Popa V. A., Godogoaga N.P., Vetricianu S.V., Andreev A.S., Tihomirov L.I., Buracovschi N.S., Unele aspecte ale complicaiilor intracraniene a otitelor
medii supurate, Tezele conferinei tiinifice a Universitii de Stat de Medicin N. Testemianu din Republica Moldova, 616.284 002.3 06: 161.831,
12-15 mai 1992
Quoted by Cawthorne, T., The surgery of the temporal bone, J. Laring. & Otol., 67:377, 1953
BIBLIOGRAFIE
1. Popa
V. A., Godogoaga N.P., Vetricianu S.V., Andreev A.S., Tihomirov L.I., Buracovschi N.S., Unele aspecte ale complicaiilor intracraniene a otitelor medii supurate,
Tezele conferinei tiinifice a Universitii de Stat de Medicin N. Testemianu din Republica Moldova, 616.284 002.3 06: 161.831, 12-15 mai 1992
2. Quoted by Cawthorne, T., The surgery of the temporal bone, J. Laring. & Otol., 67:377, 1953
Queted by Heine., Beck J., in Denker A., Kahler O., Handbuch der Hals-Nasen-Ohrenheilkunde, Vol/ 8, Berlin, 1927
Shambaugh, G. E., Jr.: The surgical treatment of meningitis of otitic and nasal origin. J.A.M.A., 108:696, 1937
Shambaugh, G. E., Michael E.G., Surgery of the ear, Third Edition, W.B. Saunders Compani, Philadelphia London Toronto, 1980, p. 289-315
tefne Mihail, Anatomia omului, Volumul 2, 2009, http://library.usmf.md/old/downloads/ebooks/Anatomia.Stefanet.Vol_2.2009/4.Sistemul_nervos_central.pdf
Turgut S, Ercan I, Alkan Z, Cakir B., A case of pneumocephalus as a complication of silent otitis media. Ear Nose Throat J 2004;83:50-2. [PubMed]
Tyler KL, Chapter 28: a history of bacterial meningitis, Handb Clin Neurol.2010;95:417-33. doi: 10.1016/S0072-9752(08)02128-3. http://www.ncbi.NLM.nih.gov/PubMed/19892131
Yorgancilar E, Yildirim M, Gun R, Bakir S, Tekin R, Gocmez C, Meric F, Topcu I., Complications of chronic suppurative otitis media: a retrospective review, Eur Arch
Otorhinolaryngol. 2013 Januarz; 270 (1):69-776
.., ,
, 616.284.253-06-07-089. 1995
.., . 2021615 27.01.94 .
.., .., .., 2020878, 1993
.., .., .., , 1994, 13
.., .., .., - .
, , 1993, . 62-67
.., .., .- , 1991, 4, .53-54
.., .., , , 1984
.., , . , 1957
.., .., .., .., ,
, .2, 1998, . 47-49
.., , ., 1966
.., , . , 1983
.., .., .., , ., 1977
.., .., .., , . , 1977
.., , . , 1985
http://www.historyofvaccines.org/content/articles/Meningococcal-disease , Different Types of Vaccines
http://www.historyofvaccines.org/content/articles/meningococcal-disease , Meningococcal Disease
http://www.immunize.org/catg.d/p4210.pdf . , Meningococcal: questions and answers. Immunization Action Coalition Web site. Accessed October 19, 2010.
http://www.ingami.info/History.html
http://www.meningitis.com/US/about/ ABOUTMENINGITIS
http://www.Meningitis.com/us/about/History-Meningitis/ HISTORY OF MENINGOCOCCAL MENINGITIS
http://ru.scribd.com/doc/107139855/INFEC%C5%A2II-ALE-SISTEMULUI-NERVOS-CENTRAL
http://ru.scribd.com/doc/142184491/04-Complicatiile-otitelor
http://ru.scribd.com/doc/145707749/MENINGITA
http://ru.scribd.com/doc/183508129/meningita-otogena
http://ru.scribd.com/doc/23475935/Otogenic-Infective-Complications
http://www.sciencedirect.com/science/article/pii/S0072975208021283
http://scienceweek.com/2005/sc050211-3.htm