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Surgery of the sinuses for years already performed access mainly through the nasal cavity, with the aid of special optical instruments (functional endonasal sinus surgery - FESS), with no visible external incisions.
Diseases of the nose and sinuses are the roads in the population, whether it is a matter of acute infectious diseases, chronic inflammatory changes / nasal polyps or allergic diseases of the mucous membrane of the nose and sinuses. Expressed their impact on reducing the overall quality of life of those affected.
It is therefore important to accurate diagnosis, which allows the proper treatment. The diagnosis of a wide variety uporebljava Searches: clinical, laboratory and imaging tests (X-ray, CT, MRI), ultrasound, etc.
The beginning is especially important that the otolaryngologist / rinolog collect as much information about the symptoms of the disease as a momentary and all other diseases of the patient, family (inherited) diseases, habits, hypersensitivity to drugs, smoking, consumption of drinks / alcohol, etc. Then follows a detailed review of classical nasal special instrument (anterior rhinoscopy), and optical instruments (flexible endofiberendoskopija) which you can see all parts of the nasal cavity, and they are inaccessible to classical examination. Then the doctor decide on further examinations relevant to the diagnosis.
Laboratory tests are important in the diagnosis of allergic diseases (allergic rhinitis). Usually determine IgE antibodies, important in the development of allergic reactions. It can be measured by the total amount of IgE in the blood, which is less frequent for all (RIST test). More information is obtained while performing the RAST test, which measures the amount of IgE that are specific to certain allergens.
Diagnostic imaging methods
Technology, at the present stage of development, provides detailed insight into medicine in all the anatomical and / or pathological features within the human organism. Therefore, quality diagnostics, based on such visual records, is a prerequisite for successful use of computer systems, preparation, management, conduct and analyze the course of treatment.
Complex diagnostic devices for computed tomography (CT), magnetic resonance imaging (MRI), ultrasound (ultrasonography), systems for nuclear medicine and other diagnostic interventional devices that use running as a result of the observed image poducja human body, enable the rapid and reliable diagnosis. By using such complex devices doctors were able to diagnose the smallest change in the anatomical relationships in the human body.
X-ray, CT scan
In the past often used the classic X-ray (RTG) paranasal sinuses. In recent times, when there are other more accurate methods, it usually has only orientational significance and is often given insufficient information about the type and extent of the disease. Extremely valuable information about the anatomic relationships in the desired region of diagnosis, planning and conducting diagnostic and endoscopic surgery, providing kvaltetna CT diagnosis.
This method is based on X-rays which a body shot layer by layer, thus obtained two-dimensional (2D) images, especially important in the diagnosis of diseases such as nasal polyps or tumors of the nasal cavity and / or sinuses. CT imaging can accurately display the extent of the pathological process, relationship to surrounding structures, and receive orientation on the type of disease.
But very often can not accurately determine the location of pathological processes in relation to the target location endoinstrumentarija and / or the tip of an endoscope, or any other instrument in space, in relation to the target location shown on the CT image. ENT surgeons are therefore forced to concentrate maximum, rely on the experience, sometimes on intuition as to allow real progress and visual operacije.Stoga was necessary to develop a novel approach (3D, VE, 3D-CAS, etc.) in view of the head patients before, during and after surgery.
The basic requirement, which arises from these needs, the use of a computer system to display the anatomical structure of the whole surgical field essential to the conduct of surgical therapy. This approach would allow the surgeon a much better insight into the operative field and considerably greater safety of the operation.
The current use of computers to display the anatomy of the entire human body, only enabled the diagnosis and possibly the preparation of operating procedures. Using computer-generated model D surgical field during the operation, the current practice is not altogether commonplace. All this is applicable in Croatian medicine since 1998. year, when the Croatian ENT surgeons, as pioneers and pioneers of this surgery, first in the world perform this type of operation and set the most demanding standards in diagnosis and surgery 21st century.
Magnetic Resonance Imaging
(MRI) is a method that does not use x-rays, but the magnetic properties of hydrogen atoms in the body, after exposed to radio frequency. Shows a significantly greater ability to display soft tissue than CT. Also used in the diagnosis of sinus disease, and pathological processes (eg, tumors), which occupy an area of the skull base and nasal part of pharynx (nasopharynx).
Also shown is the better direction of certain tumors with a detailed breakdown of extracutaneous involvement of surrounding structures. The disadvantage of this method is the relative expensiveness and still less the availability of the patient.
In the treatment of diseases of the nose and sinuses are constantly introducing new methods, as in other branches of medicine. In the treatment of allergic diseases apply newer generation antihistamines, which have much fewer side effects than the former (eg drowsiness). Corticosteroids, which are important for its anti-inflammatory action, are used most often in the form of sprays, locally on the nasal mucosa.
This reduces the possibility of systemic absorption, ie, their adverse effects. Systemic (by mouth) are taken mainly in nasal polyposis, in a special protocol (downward dose), while protecting the stomach lining. New insights are also being introduced in the surgical treatment of diseases of the nose and sinuses.
Surgical procedures on the sinuses for years already performed mostly access through the nasal cavity, with special optical instruments (functional endonasal sinus surgery - FESS), with no visible external incisions.
The development of complex computer systems and programs, it is possible to create three-dimensional (3D) imaging model for each individual patient, which provide the widest possible individualization of each procedure, and thus the accuracy and security, the reduction of possible complications to a minimum. Visual record of surgery can be transmitted via IT equipment in remote places (teledijagnostika, teleoperacija), for consultation and education experts.
Advanced Technology browsing 3D spatial models allow the simulation of endoscopic surgery and planning the future course of operations (Virtual Endoscopy), and teleoperacije (Tele-Virtual Endoscopy). Entering the models and penetration through the operable region, a surgeon with the knowledge that will face problems during real operations. This process of preparation for surgery, framing the shortest and safest way of implementing the planned future treatment.
Using 3D spatial model of the surgical field during surgery there was a need for positioning the tip of the instrument (endoscope, forceps, etc.) within the computer model. The main problem is the transfer of the coordinate system of the surgical field of real patients in the coordinate system of a computer 3D spatial model of that same patient who was previously drafted a series of CT scans during the preparation of the operation. With the help of a special digitizer models (simulation endoscope) and computer models can be prepared as well as overall operations simulation procedure on a computer model of a real patient.
Using 3D digitizer in actual operation it is possible to determine the top of the instrument (simulated endoscope) inside the actual surgical field and display it on a computer model. The freedom to manipulate the endoscope surgery is not reduced because the connection is realized on the site captures the instrument and the connection point endocamera.
The use of computers during the preparation and conduct of operations enabled us to store all important information about the patient during treatment. CT images, the results of other tests, computer display, 3D spatial models, computer records during surgery and video during the operation are stored in a computer and a CD-R devices for later analysis. Also used in education and practice of implementing different approaches to the surgical profession for residents, but often for some specialist surgical sectors. It allowed for the actual surgery and telesurgery operations and subsequently studied nedostake notice as possible to improve the surgical treatment.