Pseudomonas aeruginosa in cystic fibrosis patients with CFTRI1234V in a large kindred family

To describe the characteristics of Pseudomonas aeruginosa [P. aeruginosa] in cystic fibrosis [CF] patients with CFTRI1234V in a large kindred family in Qatar, medical and laboratory records were reviewed of 46 patients of CF with CFTRI1234V from 25 families arising from a single large Arab kindred tribe who attended the CF clinic between May 2002 and June 2008. Thirty eight CF patients, who were negative for P. aeruginosa at first lower respiratory culture, were enrolled in the study. The diagnosis of CF was confirmed by sweat test and molecular genetic study. Trypticase soy agar with 5% sheep blood, McConkey agar, oxidative-fermentative polymyxin B-bacitracin lactose agar, Hemophilus isolation agar and mannitol salt agar were used as selective media for the isolation of important CF respiratory pathogens. The prevalence of [P. aeruginosa] in lower respiratory cultures from 46 patients was 60.9%. Twenty [52.6%] of 38 CF patients with CFTRI1234V acquired P. aeruginosa with no seasonal variation. Positive siblings with P. aeruginosa were found in 70% indicating cross-infection within the family. The median [range] age at first detection of P. aeruginosa was 12.5 [1-19] years. There was no significant difference between males and females in acquisition of P. aeruginosa. P. aeruginosa of mucoid phenotype was detected in 11 [55%] of 20 with additional organisms, S. aureus being the second isolated organism in nine [81.8%] of the 11. A larger prospective study in a cohort of CF patients with CFTRI1234V in the Arabian Gulf region is required to determine the risk factors for acquisition of P aeruginosa with early aggressive antipseudomonal therapy

Tympanometric values in young Malay adults: preliminary data

<p><b>INTRODUCTION</b>The present study aimed to obtain preliminary tympanometric data of young Malay adults and to compare the results between genders.</p><p><b>METHODS</b>96 undergraduate students (49 males and 47 females), aged 19-25 (mean and standard deviation 21.14 +/- 1.31) years, participated in this study. Otoscopic examination, pure tone audiometry, qualitative tympanogram and ipsilateral acoustic reflex were measured to ensure a clear ear canal, normal hearing and normal middle ear function, prior to tympanometric measurement. As a result, a total of 154 ears (80 ears from males and 74 ears from females) were selected for further statistical analyses. The tympanometric parameters measured were peak compensated static acoustic admittance (Peak Y(tm)), tympanometric width (TW) and equivalent ear canal volume (V(ea)).</p><p><b>RESULTS</b>The results showed that the mean Peak Y(tm), V(ea) and TW for males were 0.81 mmhos, 1.48 cubic cm and 113.67 daPa, respectively. The mean Peak Y(tm), V(ea) and TW for females were 0.63 mmhos, 1.12 cubic cm and 98.04 daPa, respectively. Males were found to have significantly higher mean V(ea) and mean Peak Y(tm) than females. However no significant gender difference was observed in the mean TW.</p><p><b>CONCLUSION</b>The current study suggests that young Malay adults may require gender-specific Peak Y(tm) and V(ea) values when implementing a quantitative approach in tympanogram interpretation.</p>

Stenotrophomonas maltophilla isolated from the sputum of the patient with cystic fibrosis mutation i1234v: first qatari report

A17 year old Qatari female of Arab descent with cystic fibrosis [CF] carrying pathogenic mutation II234V had severe respiratory disease associated with chronic Pseudomonas aeruginosa broncho-pulmonary infection with recurrent episodes of mild hemoptysis. Despite regular courses of intravenous anti-pseudomonal antibiotics, she continued to deteriorate over six months and died. It is suggested that the presence of Stenotrophomonas maltophilia was an important factor in this case, which illustrates the need for continuing vigilance in considering the acquisition of resistant organisms in such patients on long-term antibiotic therapy

Pelvic hematoma resulting in obstructive uropathy

The use of anticoagulants, for whatever indication, may carry a high risk of hematoma formation following surgery. Obstructive uropathy is a very rare but possible example of complication secondary to an extensive pelvic hematoma. We describe a case of a patient with rheumatic heart disease and aortic valve replacement, who developed a massive postoperative pelvic hematoma following bilateral tubal ligation, resulting in bilateral ureteric obstructions. This was treated with bilateral ureteric stent through cystoscopy

Routine ultrasound in acute retention of urine

To evaluate the frequency of urological abnormalities in routine urinary tract ultrasonography [renal and pelvic] in patients with urinary retention secondary to benign prostatic hyperplasia. All patients presented to Salmaniya Medical Complex, Bahrain with acute retention of urine secondary to benign prostatic hyperplasia [BPH] in the period between January 2001 and December 2001 were included. The frequency of urological abnormalities, other than BPH, was obtained. One hundred patients were enrolled with a mean age of 67 years. Forty-one patients [41%] had other urological abnormalities. Among these, 3 cases of malignancy were discovered incidentally. A case of renal cell carcinoma, which was completely excised, and 4 cases of bladder tumor, 2 were new cases and 2 were previously known cases of cancer bladder. Other urological abnormalities were renal stones [9 cases], renal cysts [9 cases], hydronephrosis [14 cases] and bladder stones [5 cases]. Asymptomatic non-urological abnormalities were gallstones [3 cases], liver cirrhosis [one case] and hepatic hemangioma [one case]. Renal impairment was found in 18% of all patients and 80% with hydronephrosis. Four patients had hypoechoic nodules, and all had cancer prostate. Significant fraction of patients with acute urinary retention due to BPH have another pathology; although the majority are trivial and it did not influence the immediate management, some are life threatening such as renal cell carcinoma and bladder tumor. Hydronephrosis can be missed if one depends solely on renal biochemistry. Thus, routine evaluation of such patients with pelvic and renal ultrasonography is justified

Induction chemotherapy followed by concurrent chemoradiotherapy in the management of locally advanced cancer larynx

This study was performed on 24 patients aiming to determine the efficiency and toxicity of neoadjuvant chemotherapy, followed by concurrent chemoradiotherapy. They received three cycles of platinol, leucovorin and 5-flurouracil, followed by concurrent chemoradiotherapy using cisplatin 20 mg/m2 weekly. After induction therapy only, 2 patients showed a complete clinical response, while 18 patients showed a partial response and 4 remained with progressive disease. After completion of chemoradiotherapy, 85% of the patients showed a complete remission clinically, endoscopically and by histopathological study, while 4 patients showed a partial response and underwent palliative laryngectomy

CT-guided percutaneous biopsies of parapharyngeal space lesions

Fine needle aspiration biopsy [FNA] of superficial and deep-seated lesions of the head and neck has been used extensively with high sensitivity and specificity. Several articles have stressed the role of computed tomography in detecting and staging head and neck tumors. FNA has been paired with imaging guided localization for the cytologic assessment of lesions in the parapharyngeal space. This work presented a series of 30 CT-guided percutaneous biopsies performed between January 1997 and January 2000 at Assiut University Hospital. The age of the patients ranged from 13 to 60 years [mean 37] with 21 males and 9 females. Analysis of the results showed 8 inflammatory lesions, 12 benign tumors and 10 malignant neoplasms. Correlation with histopathology of true-cut needle or incisional biopsy showed a diagnostic accuracy of 88.0% but certain lesions could not be diagnosed by this procedure. FNA can replace incisional biopsy, which may be hazardous in this area. Surgery can be avoided for inflammatory lesions

Cholesteatoma histological study

The study included 30 patients with middle ear cholesteatoma; the specimens were obtained from patients undergoing ear surgery for cholesteatoma. The examination also included seven samples of normal external auditory canal skin, five samples of the middle ear mucosa adjacent to cholesteatoma. The specimens were processed for both light and transmission electron microscopy. Flattening of the cells and morphological characteristics resemble that of the external canal skin was found. The mucosa adjacent to the cholesteatoma was found diseased with impaired mucociliary function. The ultrastructural arrangement of the basement membrane is like that of skin. The study showed the role of retraction pockets in cholesteatoma development. Because of the inflammatory reaction in the mucosa adjacent to cholesteatoma, thorough irrigation during surgery and antimicrobial therapy after surgery are warranted

Endonasal laser dacryocystorhinostomy

The nasal lacrimal apparatus is intimately related to the lateral nasal wall and may readily be approached using an endoscopic technique. Endoscopic laser assisted lacrimal surgery is a new technology, which was applied in our patients. The studied group included 10 patients [7 females and 3 males] ranging in age from 6 to 66 years. The main symptoms were epiphora and discharge. The main site of obstruction was at the nasolacrimal duct [determined by the dye test and dacryocystography]. Laser was applied under general anesthesia to evaporate the nasal mucosa opposite the lacrimal sac, ablate the under lying bone and excise the medial wall of the lacrimal sac. The patients were followed up for one year. The patients maintained a patent opening and had no recurrence of epiphora. The technique avoids a cutaneous scat and causes less surgical trauma and bleeding without major complications

Radiology, ultrasound and endoscopy in the diagnosis of chronic sinusitis

This study was directed to evaluate the ultrasonographic examination of the paranasal sinuses, compared with conventional plain radiography after confirming the diagnosis endoscopically. Computerized tomography was the standard diagnostic tool. The study comprised 20 patients [13 males and 7 females], attending the Ear, Nose and Throat Department of Assiut University Hospital. The majority of the patients were in the 2nd decade of life. The most common symptoms were post nasal discharge, nasal obstruction and headache. Conventional radiographic study was more sensitive than ultrasonography in disease detection [88.88% versus 65.59%], while ultrasound [US] and endoscopy were nearly of the same sensitivity. Ultrasound was found to have higher specificity value in the detection of mucosal thickening and polyp formation, but less specific for fluid level detection. Ultrasonography may be considered as a specific diagnostic tool of the sinusitis

Management of obstructive sleep apnea syndrome in patients with temporomandibular joint ankylosis associated with facial deformities

This study aimed to investigate the mechanism of obstructive sleep apnea syndrome [OSAS] in patients with retrognathia resulting from long-standing temporomandibular joint [TMJ] ankylosis to establish their correct management. Six patients suffering from retrognathia caused by long-standing TMJ ankylosis were subjected to polysomnography. These patients were offered mandibular or maxillomandibular and hyoid advancement. In addition, vulopalatopharyngeoplasty was done in one patient. All patients were clinically, radiologically, polysomnographically and endoscopically evaluated before and after surgery. The clinical preoperative evaluation proved that three patients were mainly presented with snoring and sleep apnea, while the remaining three patients were mainly presented with facial deformity, limitation of mouth opening or both. All patients were proved to have snoring and repetitive apneic attacks, but only three had excessive day somnolence. They also had facial deformity and limitation of mouth opening. Cephalometric analysis proved the presence of mandibular retrusion, shortening of the lower face height, narrowing of the posterior airway space and lengthening of the soft palate and uvula. Endoscopic evaluation showed that such patients had narrowing of the upper airway at three levels [retropalatal, the vertical space between the soft palate and tongue and the retroglossal airway], except one patient who had wide retropalatal airway. A collapse occurs due to backward and upward displacement of the tongue, which does not only cause airway narrowing at the retroglossal but also at the retropalatal airway. This creates a collapsing segment that extends from below the base of the tongue as high as the soft palate. All patients had surgical planning that included presurgical orthodontic evaluation, prediction tracing and model surgery with preparation of occlusal splints. All patients had mandibular advancement that was accompanied by maxillary advancement in three patients. Advancement genioplasty was done in two of them. One patient needed uvulopalatoplasty, in addition to the advancement procedure. According to postoperative polysomnography, five patients had a successful result and one patient had worsening of sleep apnea. Widening of the airway was demonstrated by cephalometric and endoscopic evaluation, except that patient with worsening of the sleep apnea that had more bulging of the lateral pharyngeal walls during endoscopic examination. The complications included infection, salivary fistula, recurrence of ankylosis, injury of the marginal branch of the facial nerve, malocclusion and worsening of sleep apnea

Tympanometeric changes following tonsillectomy and nasal packing

The effect of nasal packing and tonsillectomy on the middle ear pressure was investigated. Forty% of patients with bilateral anterior nasal packs had a negative pressure corresponding to type C1 and C2. However, the incidence of negative middle ear pressure with posterior packing was high [80%]. 53% of tonsillectomy patients developed negative middle ear pressure. No patients in this series developed middle ear effusion probably because the tubal dysfunction was partial and of short duration. Patients after tonsillectomy and nasal packing were advised to be examined otologically to exclude persistent negative middle ear pressure

Precipitation of hepatic encephalopathy by propranolol

Propranolol is used to prevent recurrent variceal bleeding in patients with periportal hypertension and cirrhosis. Though controversy still exist regarding its efficacy in these conditions, its potential to precipitate hepatic encephalopathy is rarely reported. In this case report, we describe a patient who developed severe hepatic encephalopathy shortly after porpanolol treatment and recurred on rechallenge with the drug