ABSTRACT
To study the clinical profile of angiofibroma, various conventional surgical approaches and the outcome of surgery. Prospective, analytical study. This study was conducted at the Department of Otorhinolaryngology and Head and Neck Surgery, Bolan Medical Complex Hospital, Quetta from January2008 to December2012. This study included 31 patients of juvenile nasopharyngeal angiofibroma over a period of 5 years. All patients were treated by conventional surgical approaches following Fisch staging system. Twenty one [21] patients were operated by lateral rhinotomy approach, Three [3] patients by transpalatal approach, five [5] patients by Weber-Fergusson approach and two [2] by Mid-facial degloving approach. The patients were followed up for a period of three [3] years for any recurrence. All patients were male with mean age 15.61 +/- 2.64 years. The patients presented with recurrent epistaxis, nasal obstruction and nasopharyngeal mass apart from other symptoms and signs. Majority of the patients [80.64%] came with stage II and IIIA disease. Lateral rhinotomy approach was used in majority of cases [67.74%]. Recurrence was observed in 5 cases [16.12%]. Recurrence rate was less [one out of 2leases] with lateral rhinotomy approach in comparison with other approaches. In transpalatal route recurrence was observed in two [2] cases out of three [3] cases, while in Weber-Fergusson approach it was one out of five [5] and in Mid-facial degloving it was one out of two [2] cases. Juvenile nasopharyngeal angiofibroma is a disease of male adolescents. The patient most commonly presents with recurrent epistaxis and nasal blockage with nasopharyngeal mass. Surgery is the treatment of choice. Lateral rhinotomy approach gives an excellent exposure for most of these tumours with less chance of recurrence
ABSTRACT
The present study was undertaken with the aim to detect bacteria and fungi as aetiological agent in CSOM and to see susceptibility pattern of bacterial isolates to different antibiotics and to determine the beta lactamase production by the bacterial isolates. Experimental Study. This study was conducted in the department of Microbiology, Basic Medical Sciences Institute, JPMC, Karachi, during the period of August 1998 to February 1999. During this period, 110 patients were seen, of them 62 were male and 48 were female with male to female ratio of 1.3:1. Two swabs were taken from each patients ear, one was put immediately in to Brain Heart Infusion [BHI] broth and the other was inoculated on Sabouraud Dextrose Agar [SDA] slant. BHI was incubated for 2-4 hours and subcultured on blood agar, chocolate agar and MacConkey's agar plates. The Chocolate agar was incubated in 5-10% CO[2] atmosphere in a candle jar and they were incubated for 24 hours at 37°C. SDA slant was incubated for 14 days at 37°C. Isolates were identified by Gram staining and then confirmed by biochemical test. Fungus growth was stained in Lactophenol Cotton blue [LPCB] and identified microscopically. Amongst bacterial isolates gram negative rods [41] and Pseudomonas aeruginosa [45] were predominant. 47 gram positive cocci were seen, of those 37 were Staphylococcus aureus. Fourteen fungal isolates were recovered, all of them were found to be Aspergillus species. Bacterial isolates were tested for beta-lactamase production the drug sensitivity was noted by disc diffusion method on Mueller Hinton agar. Ciprofloxacin and Enoxacin emerged as the most effective antibiotics. Tobramycin also showed good results against gram negative rods and Pseudomonas aeruginosa. Chloramphenicol, Clarithromycin and Minocycline showed good results against Staphylococcus aureus. And other gram positive cocci. Drug sensitivity of the fungi was not done. Micro-organisms showed least sensitivity to Ampicillin and Cotrimoxazole. It is concluded that to achieve the maximum benefits of antibiotics, we must use them with discrimination and with the understanding of microbial population and with the knowledge of their indications and limitations. The indiscriminate, haphazard and halfhearted use of antibiotics and poor follow up of patients causes more harm than good