Operative management of external auditory canal cholesteatoma: case series and literature review.

OBJECTIVES: To describe the clinical features of external auditory canal cholesteatoma, and to assess the outcome following bony meatoplasty with tragal cartilage and perichondrium graft repair. METHODS: A retrospective review was carried out, comprising all patients with external auditory canal who presented between January 2007 and December 2011. Patients underwent pre-operative audiometry and computed tomography imaging of the temporal bones, before undergoing bony meatoplasty via a postauricular incision. Pre- and post-operative comparisons were made of patients' otological symptoms and the otoscopic appearance of the external ear canal. RESULTS AND CONCLUSION: Eight patients were included in the analyses. The median age of patients was 46.5 years (range 14­68 years), with a male to female ratio of 1:1. The median length of follow up was 16 months. The most common presenting features were unilateral otalgia and purulent otorrhoea. All patients had relatively advanced disease at presentation, with erosion of the temporal bone. All patients underwent bony meatoplasty via a postauricular approach to eradicate the disease. Bony meatoplasty was successful in the definitive management of external ear canal cholesteatoma.

Physiological response of Epipremnum aureum for cobalt-60 and cesium-137 translocation and rhizofiltration.

In this study, three separate experiments were carried out to explore the potential of Epipremnum plants for Co-60 and Cs-137 uptake and rhizofiltration from solutions. Experiment I was carried out to screen the effects of different concentration (0-10 mM) of stable Co and Cs salts on some physiological components of the Epipremnum over 20 d. Data from the experiment showed that 1 mM of either Co or Cs had no adverse effects on the chlorophyll, soluble sugar, and protein of Epipremnum. Over 20 d at a high concentration (10 mM), some effects of Co or Cs were detectable but were not inhibitory. Experiment H showed an increase in the concentration ratios (CRs) of carrier-free Co-60 and Cs-137 relative to their concentration in the solution. Transport indexes (TIs) of Co-60 only increased with increasing its concentration in the solution. CRs increased with time and more than 50% of Co-60 and Cs-137 was detected at 5 d. Based on the data obtained from experiments I and II, both stable Co and Cs were used as carriers for Co-60 and Cs-137 to study their uptake and translocation in Experiment III. It was found that the Epipremnum plant had bioconcentration factors (BCFs) of 10.69 and 2.26 for Co and Cs, respectively. However, TI was 13.8 for Co and 35.6 for Cs. The accumulation of Co-60 and Cs-137 in the roots of Epipremnum might offer a method for Co-60 and Cs-137 rhizofiltration.

Typhoid osteomyelitis of the lumbar spine.

A 25-year-old Nepali man presented with a 20-day history of fever associated with a lower backache. Physical examination found tenderness over the lower lumbar vertebrae. Magnetic resonance imaging following intravenous contrast injection showed enhancement of the L4 and L5 vertebrae, particularly pronounced around the intervening disc, and areas of endplate erosion. Extra-vertebral enhancement and a small subligamentous anterior collection were also noted. Computed tomography-guided needle aspiration was performed at the level of L4/5 disc material and culture of the specimen grew Salmonella typhi sensitive to ampicillin, ciprofloxacin, and ceftriaxone. The patient received intravenous ampicillin 2 g per 4 hours for 6 weeks. The back pain resolved completely and the patient was discharged. Typhoid osteomyelitis of the spine should be considered in the differential diagnosis in patients from endemic areas who present with fever and backache.

Pre-eclampsia: epidemiology and outcome of 995 cases.

OBJECTIVE: To study the epidemiology and pregnancy outcome of pre-eclampsia at Ain Shams University Hospital for Obstetrics and Gynecology. STUDY DESIGN: A case control study involved 995 cases of pre-eclampsia, 227 cases with chronic hypertension and 1375 cases with normal pregnancy delivered during the year 2000 at Ain Shams University Maternity Hospital. All these cases were critically analyzed regarding to some risk factors as age, parity, blood group, diabetes mellitus, Rhesus factor and multiple pregnancy. The outcomes of all these 3 groups were compared regarding to maternal and fetal morbidity and mortality. RESULTS: Pre-eclampsia was more common in elder age, blood group B, in Rhesus negative, during summer, multiple pregnancy and in patients with diabetes mellitus. The difference was statistically significant regarding all these risk factors (p < 0.01) when compared with cases of chronic hypertension and patients with normal pregnancies. CONCLUSIONS: In this work pre-eclampsia was found to be an important cause for maternal and fetal mortality. Also it was found to be an important cause for premature deliveries.

Absorbed dose and deterministic effects to patients from interventional neuroradiology.

Following the presentation of radiation-induced skin effects by three patients who had undergone glue embolisation of intracranial arteriovenous malformation (AVM), measurements were made of absorbed dose to the skin of patients undergoing other interventional neuroradiological procedures that involve long fluoroscopy times. The maximum absorbed dose to the skin measured by thermoluminescent dosemeters during these procedures was 4 Gy. From these measurements and from records of fluoroscopy time and the number of digital runs acquired, estimates of the maximum absorbed skin dose were made for the AVM patients. The best estimate of maximum absorbed dose to the skin received by any of the AVM patients during a procedure was 5 Gy, which is consistent with the skin effects presented by the AVM patients, that is temporary epilation and main erythema. Maximum absorbed dose to the skull was estimated to be 45 Gy and to the outer table of the skull 55 Gy. Although it is unlikely that the AVM patients will suffer serious effects from these skin doses, there remains some uncertainty over the risk of long-term effects to the skull. Examination of the fluoroscopy unit showed that the image intensifier was not performing optimally in terms of entrance dose rate and resolution. Replacement of the unit with modern X-ray equipment designed for interventional radiology was prioritized. Operators should be aware of the potential risks to patients from complex interventional neuroradiology procedures and should optimize their procedures to minimize such risks. Patients undergoing prolonged and complex procedures should be counselled regarding the symptoms and risks of large doses of radiation.

Bilateral traumatic caroticocavernous fistulae: total resolution following unilateral occlusion.

Balloon occlusion is the accepted treatment for direct posttraumatic caroticocavernous fistula. We present a case of bilateral traumatic fistulae associated with a pseudoaneurysm. Resolution of both fistulae occurred following treatment of one of them by balloon occlusion of the internal carotid artery. This case highlights the importance of considering a more conservative approach to bilateral fistulae or those associated with a pseudoaneurysm. We review other treatment options.

Cervical epidural lipoblastomatosis: changing MR appearance after chemotherapy.

Lipoblastomatosis is a locally infiltrative tumor of embryonic fat. We describe the MR appearance of cervical lipoblastomatosis with epidural extension. The initial MR study showed features of a soft-tissue mass; a subsequent MR examination, performed after chemotherapy, depicted the lesion as a typical lipoma of high signal intensity on T1-weighted images and of intermediate signal on T2-weighted sequences.