Traumatic transnasal penetrating injury with cerebral spinal fluid leak.

CSF leak in penetrating skull base injury is relatively rare compared to close head injury involving skull base fracture. We report a 5-year-old boy presented with epistaxis and impacted pencil into the left nostril. The child was hemodynamically stable without any neurological deficit. Intraoperatively, there was a nasal septal defect posteriorly with anterior skull base fracture associated with CSF leak. The pencil was removed from the left nostril and the CSF leak was repaired using harvested abdominal fat under the same setting. Computed Tomography (CT) of the brain showed right cribriform plate fracture with small pneumocranium. Postoperatively, a prophylactic antibiotic was given for seven days and he was discharged well. Subsequent clinic visits up to one-year postoperative period showed no recurrence of the CSF leak. History taking, physical examination and CT imaging give valuable diagnostic values in managing the penetrating skull base injury. Early intervention for removal of the foreign body and repair of the CSF leak is advocated to prevent catastrophic complication.

Ethnicity influences disease characteristics and symptom severity in allergic rhinitis patients in Malaysia.

BACKGROUND: The number of available reports regarding the influence of ethnicity on clinical features of allergic rhinitis (AR), especially disease severity in tropical climates, is limited. We aimed to compare clinical parameters and disease severity in AR patients of different ethnicities. METHODS: Malay, Chinese, and Indian AR patients (n = 138) with confirmed sensitivity to Dermatophagoides pteronyssinus, Dematophagoides farinae, and Blomia tropicalis were tested for mite-specific immunoglobulin E (sIgE) levels. A detailed questionnaire was used to collect data on nasal symptom score (NSS), ocular symptom score (OSS), sum of symptoms score (SSS), quality of life score (QLS), symptomatic control score (SCS), and total sum of scores (TSS) and correlate the derived data with patients' demography, mite-polysensitivity, and sIgE levels. RESULTS: AR-related symptoms were most severe in Malays and least in Chinese (p < 0.01). Age (r = 0.516 to 0.673, p < 0.05) and duration of AR (r = 0.635 to 0.726, p < 0.01) correlated positively with severity domains (NSS, SSS, QLS, and TSS) in Chinese. Duration of concurrent allergies was highest in Malays (p < 0.05). Polysensitivity predicted increased sIgE levels in Malays (r = 0.464 to 0.551, p < 0.01) and Indians (r = 0.541 to 0.645, p < 0.05) but affected NSS, SSS, and TSS only in Indians (r = 0.216 to 0.376, p < 0.05). sIgE levels were lowest among Chinese but correlated strongly with NSS, OSS, SSS, and TSS (r = 0408 to 0.898, p < 0.05). CONCLUSION: Clinical parameters in AR may be influenced by race. Symptoms were most severe among Malays but did not correlate with other variables examined. Although Indian ethnicity did not impact disease severity, duration of concurrent allergies and mite-polysensitivity was associated with more severe disease. Age, duration of disease, and sIgE levels may be useful indicators of disease severity in Chinese.

Drainage post-thyroglossal duct remnant surgery: possible source and analysis.

OBJECTIVE: To establish the distance between tongue base salivary tissue and hyoid. Also, to identify protein differences between thyroglossal duct (TGD) remnants and salivary tissue in order to distinguish drainage source post Sistrunk surgery. METHODS/SETTING: The anterior neck block was obtained from 10 adult cadavers with no known neck pathology. The distance between the normal salivary tissue and hyoid was measured histologically. Immunohistochemistry (IHC) was then performed on 20 archived tissue blocks from pediatric patients post Sistrunk surgery to identify the presence of amylase, MUC5AC (tracheobronchial mucin), and MUC7 (salivary mucin) within the excised specimen. RESULTS: Average distance between salivary tissue and the hyoid within adult human cadavers was 3.3 mm (range, 1.0-4.2 mm). IHC revealed all excised TGD remnants contained amylase and MUC5AC but none contained MUC7. Both amylase and MUC7 were present within adjacent salivary tissues. CONCLUSIONS: Salivary tissue of the tongue base normally resides an average of 3.3 mm from the hyoid within the adult population. Biochemical analysis showed MUC5AC was specific for TGD remnants while MUC7 was specific for salivary tissue. Amylase does not distinguish between the two tissues.