Unsuspected breast carcinoma presenting as orbital complication of rhinosinusitis.

We report a rare clinical presentation of breast carcinoma metastasis to the ethmoid sinuses, orbit and cavernous sinus in a 70-year-old lady with unsuspected breast carcinoma who presented with clinical features of acute ethmoiditis, orbital cellulitis and cavernous sinus thrombosis. The patient underwent endoscopic ethmoidectomy and histology of the necrotic tissue from the ethmoidal cells was positive for endovascular neoplastic emboli. Subsequent examination revealed a large mass in the left breast, tethered to the skin, which was histologically confirmed to be a carcinoma. The patient died 2 months post-diagnosis. To our knowledge, this is the third case manifesting with combined features of ethmoiditis, orbital cellulitis and cavernous sinus syndrome from an unsuspected breast carcinoma. This case highlights the importance of imaging and thorough physical examination when a dramatic clinical picture presents in the paranasal sinuses of an otherwise healthy individual. Such manifestation of breast carcinoma is difficult to diagnose, and therefore, a high index of suspicion should be maintained. Skull base metastases from breast carcinoma behave aggressively and if diagnosed early, treatment may prolong survival and improve quality of life.

Seasonal variation and weather effects on road traffic accidents in Riyadh city.

The monthly variation of Road Traffic Accidents (RTAs) in Riyadh city in the period 1989-1993 has been studied with reference to time of day, lighting conditions and prevalent weather conditions. Total RTA accidents were significantly more common, being directly correlated, with increased dry and wet bulb temperatures and significantly less common, being inversely correlated, with increased relative humidity and amount of precipitation of rain, snow, hail etc. However, RTAs recorded on rainy days only were significantly more common and directly correlated with precipitation (Note days of snow and hail are very rare in Riyadh city). Seasonal variation in RTAs was evident being maximal during the summer season particularly between 12 noon and 3 pm. This period is characterized by heavy traffic and intense sunlight. The role of hot weather prevalent in Saudi Arabia, where average temperatures of 34.4-34.7 degrees C with maximum of 40-42.7 degrees C are common in summer, have been suggested to be an important factor leading to increased stress and decreased performance of intellectual tasks which require considerable physical effort and motor skills. Increased heart rates, exacerbation of existing pathologic conditions such as heart disease and emphysema and loss of visual acuity have been reported. Consequently, prolonged exposure to heat must be considered as a hazard to the safety and health of drivers and a factor leading to an increased incidence of RTAs.

Aetiological factors contributing to road traffic accidents in Riyadh City, Saudi Arabia.

The study analysed 13,390 police records of road traffic accidents (RTAs) covering a three and a half year period according to different suspected aetiological factors. The majority of the accidents were recorded for vehicles in good condition on well-paved straight roads with well-operating traffic light systems. Adverse weather conditions such as precipitation, fog and dust were of minimal importance, with most of the accidents being reported during sunny days during the rush period of 12 noon to 3 pm. Driver's error was identified as the main contributing factor in about two thirds of all RTAs mainly as reckless driving and excess speeding. About 27% of the drivers were professional drivers and 41% were in the age group 25-35 years in good health with no alcohol or drug intake. Hence, human errors may be attributed to carelessness, experience, lack of knowledge or attention, over-exhaustion or fatigue. The effects of physical stressors on performance of drivers need to be further explored and clarified but this need not underestimate the importance of vehicle and environment since most accidents are multifactoral and a slight change in them may effectively enhance perception and minimise personal error. Recommendations for remedial measures adopting an interdisciplinary approach are presented.

Long distance travel by children for tonsillectomy: experience of the ORL department at Princess Alexandra Hospital (PAH), Royal Air Force, Wroughton, Swindon.

An audit was carried out to assess the acceptability of long distance travel for elective tonsillectomy and adenoidectomy. Seventy nine children travelled 70 miles with their father or mother to P.A.H. from Mid Glamorgan where the E.N.T. waiting list delay for tonsillectomy was some two years. Most of the families who were offered the travel arrangements agreed and from the results of the questionnaires answered by the first 50 families, it was shown to be a successful exercise as both the children and parents were very happy with the arrangements and there were no complications.

Rhinomanometry evaluation of the effects of pre- and post-operative SMR on exercise.

Nasal airway resistance due to uncomplicated DNS was examined in 43 patients, and the results compared with those obtained following corrective surgery. The patients were examined independently by the two authors using a strict examination protocol. Rhinomanometry was carried out pre- and post-operatively at rest and after exercise assessing the worst and the better breathing nostrils separately. The results show that both resting and post-exercise nasal resistance was reduced following septal surgery.

Dermoid cyst in the mouth: value of ultrasound.

Teratomas including dermoid cysts occur in approximately 1:4000 births with the incidence in the head and neck varying according to different authors between 1.6 and 6.9 per cent. The case presented is of a 28-year-old Caucasian male in whom a dermoid cyst occurred in the floor of the mouth where ultrasound was found useful in the pre-operative assessment. The role of ultrasound in the pre-operative management of lesions in the head and neck is discussed.

Liposarcoma in the pharynx.

A rare case of an atypical lipoma in the pyriform sinus is described with an unusual presentation and some difficult histological features. Excision was performed endoscopically, there has been no evidence of recurrence for over a year. External surgical excision is reserved in case of recurrence of the tumour.

Carcinoma of the tonsil.

One hundred and twenty-two cases with squamous cell carcinoma of the tonsil have been reviewed, 101 of which were treated with radiotherapy; the five-year survival rate in these cases was significantly better in early-stage tumours. Surgical treatment in this series was too small to draw any firm conclusion but, from reports in a large series, surgical treatment has been highly recommended in selected cases of advanced tumour, this result could also be improved with a pre-operative course of radiotherapy.

Spindle cell carcinoma of the nasopharynx.

A case of spindle cell carcinoma of the nasopharynx is reported and its current management is reviewed. Surgical excision of the nasopharyngeal tumour may be the treatment of choice in some cases.