Medical education: an audit of an overseas postgraduate training programme in ENT.

For overseas doctors, looking for higher training posts, the chance of being employed in the developed countries is becoming bleaker. This article considers the need for an increase in the number of local postgraduate training programmes in the Arab world in keeping with other developing countries. The model used for this study was an internal audit, of the postgraduate programme in ENT offered by King Faisal University in Dammam, Saudi Arabia. A dropout rate of more than 30 per cent among those who joined the programme reflected either the tougher standard of the course, or an inappropriate selection process. A major reason was the frustrating inability of the trainees to cope with the basic sciences course. This point was also addressed in the audit with a view to rationalizing the course to meet specific objectives.

Lipoid proteinosis: Clinical genetic, and pathological study of a Saudi Arabian family.

We present the morphological features and clinical progression of lipoid proteinosis observed in six patients from a Saudi family. The index case presented with hoarseness and characteristic skin lesions. Some of the patients had photosentivity with milia and hypertrichosis. The diagnosis of lipoid proteinosis was confirmed by histopathology and by the findings of normal blood porphyrin levels. The condition is inherited as an autosomal recessive disorderm and consanguinity was an important factor. The rarity of this condition and the common occurrence of close-relative intermarriages in Saudi Arabia prompted this report, which we believe is the first and largest family with lipoid proteinosis possessing an established Arabian ancestry.

The paratemporal segment of the maxillary sinus: a new sign for assessment of size.

The area of the maxillary antrum in Waters' view has been measured in 68 patients using a mechanical planimeter. The mean area was 6.04 +/- 0.25 cm2. The part of the antrum lateral to the innominate line (defined as the paratemporal segment) has a mean area of 0.72 +/- 0.07 cm2. The latter diminishes in small antra and approaches zero when the total antral area falls below 3.48 cm2. It is proposed that the innominate line (Stenvers), or its extension, descends lateral to the field of the small maxillary sinus and may be used as an additional sign of such abnormality.

A modified incision for the trans-septal trans-sphenoidal approach to the pituitary.

The role of the otorhinolaryngologist in trans-septal trans-sphenoidal approach to hypophysectomy when undertaken conjointly with the neurosurgeon is to provide excellent and rapid exposure for the necessary neurosurgical manipulation. For the past two years at the King Fahd Hospital of the University in Al-Khobar, Saudi Arabia, a modified incision for the trans-septal trans-sphenoidal approach to the skull base around the area of the sella turcica has been undertaken in eight cases. This incision may offer a good alternative to the standard hemi-transfixation incision.

Local iatrogenic complications in nasopharyngeal rhinoscleroma.

The possible role of surgical manipulation in inducing local spread and cicatricial complications in rhinoscleroma is illustrated by the three cases discussed in this paper. This is especially so where its occasional presentation as polypoid lesions of the lower respiratory tract may mimic other more sinister lesions and lead to unwarranted invasive procedures by the unsuspecting clinician. The infective nature of the lesions must be appreciated and confirmed microbiologically for appropriate drug treatment to be used. The benefits of minimal surgical intervention are illustrated in the third case.

Morphological alterations in the nasal mucosa in heat stroke.

A preliminary histomorphological examination of the nasal mucosa of 8 heatstroke patients who presented without epistaxis, showed stromal vascular damage and degenerative changes in the basal lamina of the overlying epithelium, severe enough in two cases to indicate impending epistaxis, even in the absence of disseminated intravascular coagulation (DIC). It is suggested that direct damage by the extreme heat to mucosal structures, especially the prominent, thin-walled blood vessels, plays an important role in the genesis of epistaxis in heatstroke even in the absence of DIC.

Chondroblastoma of temporal bone: unusual histologic features.

Chondroblastoma of bone only rarely affects the skull and, depending on its location, may have an uncertain prognosis. The histologic spectrum demonstrated by this tumor has been a source of diagnostic confusion, which still persists. A case of chondroblastoma of the temporal bone with unusual histologic features is presented and discussed. Chondroblastoma must be included in the differential diagnosis of bone tumors of the skull containing giant cells. Radical excision is suggested as the treatment of choice in view of unanswered questions regarding its tendency to recur or to progress to frank malignancy.

Plasmacytoma of the nasopharynx (a case report with a follow-up of twelve years).

A case of plasmacytoma of the nasopharynx with a 12-year follow-up is reported. The difficulty in clinical and histological diagnosis is stressed. Despite the development of multiple metastatic lesions, repeated investigations for multiple myeloma were consistently negative. The patient was treated with a combination of radiotherapy, surgery and chemotherapy at different stages of the disease.

Intralaryngeal arytenoidectomy. A report of six cases.

Six cases of bilateral abductor palsy with stridor are presented. Following unilateral intralaryngeal arytenoidectomy, four had adequate airways and reasonable voices. Two required bilateral arytenoidectomy, one acquired an adequate airway at the expense of a weakened voice, and the other still requires a tracheostomy. There was only one minor complication. Decannulation and discharge from hospital were usually rapid.

Carcinomatous changes in pharyngeal diverticula.

This paper presents a 10-year review of 70 patients treated for pharyngeal diverticula at Wythenshawe Hospital, Manchester. The presenting symptoms, diagnosis and the different methods used to treat them are discussed. The incidence of carcinomatous changes occurring in these pouches is noted and three such cases are documented.

Malignant tumours of the trachea.

The clinical presentation and pathological findings in 37 patients with a malignant tumour of the trachea are reviewed. Treatment with radical radiotherapy resulted in a 5 year survival rate in excess of 40%.