Prevalence of generalized anxiety disorder in patients with rheumatoid arthritis and its relationship with disease activity

Background: rheumatoid arthritis [RA] is a lifelong disease with a progressive disabling course and individuals with RA experience higher levels of psychological distress than general population

Objective: The objective of the present study was to assess the prevalence of generalized anxiety disorder [GAD] in RA patients and determine its relationship with disease activity

Patients and Methods: The study included 200 RA cases. Psychiatry examinations of all cases were performed according to Hamilton scale. Patients who suspected to have GAD were further assessed by the most recent diagnostic criteria for GAD in diagnostic and statistical manual of mental disorders fifth edition [DSM-5] and psychiatry assessment sheet [PAS]

Results: The prevalence of GAD in RA cases was 38.5% [n=77] assessed by psychiatry assessment sheet [PAS]. RA patients with GAD significantly showed higher disease activity measures than those without GAD [P value <0.001]. It was found that GAD did not related to disease duration [r=0.617; p value >0.05] or RF positivity [r=0.058; p value >0.05]

Conclusion: Generalized anxiety disorder [GAD] is common to occur in RA cases. Disease activity was significantly higher in RA cases with GAD than RA cases without GAD. GAD was found to be not related to disease duration

Assessment of the drug therapy for sexually transmitted diseases in the White Nile State-Sudan

Irrational drug prescribing is a global problem. It results in development of resistance to antimicrobials, ineffective treatment, adverse effects and economic burden on patient and society. This study was carried out to assess the use of drugs for treatment of sexually transmitted diseases [STDs] and to determine their prevalence in the White Nile State-Sudan 2002-2003. Twenty urban health centers were selected randomly, 30 prescriptions were collected from each health center and assessed against recommended standard therapy. The appropriate drug therapy according to diagnosis was selected in only 10.6% of the collected prescriptions, only 42.2% of them were with appropriate doses and duration of therapy, poly pharmacy was detected in 28.8%, generic prescribing in 35.5% and possible drug-drug interactions in 17.3% of the total collected sample. The prevalence of STDs among total patients was 1.9%. 78.8% of the cases were females, 59.3% were 15-29 years old and Kenana Health Centers showed the highest prevalence of STDs 3.4%. [P<0.05] The results of the present study revealed that prescribing practices for the treatment of STDs were illogical; the reference chart prepared by federal ministry of health Sudan National HIV/AIDS/STD program must be reevaluated, because it is inappropriate and illogical. Continuous training courses are urgently needed locally and nationally to raise the updating levels of medical

Managing a case of extensively drug-resistant (XDR) pulmonary tuberculosis in Singapore

<p><b>INTRODUCTION</b>Extensively drug-resistant tuberculosis (XDR-TB) is an emerging global health risk. We present the first case report of XDR-TB in Singapore.</p><p><b>CLINICAL PICTURE</b>A 41-year-old Indonesian lady with previously treated pulmonary tuberculosis presented with chronic cough. Her sputum was strongly acid-fast bacilli positive and grew Mycobacterium tuberculosis complex resistant to first and second-line TB medications.</p><p><b>TREATMENT</b>She received 5 months of intensive multidrug treatment without sputum smear conversion. She then underwent resection of the diseased lung. The total cost incurred amounted to over S$100,000.</p><p><b>OUTCOME</b>She achieved sputum smear/culture conversion post-surgery, but will require further medical therapy for at least 18 months.</p><p><b>CONCLUSION</b>XDRTB is poorly responsive to therapy and extremely expensive to manage. Its prevention by strict compliance to therapy is paramount.</p>

Comparison of cervicovaginal proinflammatory cytokines with fetal fibronectin and cervical length in predicting preterm labor in Egyptian woman

Spontaneous preterm birth remains a significant problem allover the world despite increase research to decrease its prevalence. Strategies have been limited by inability to identify patients at risk for preterm birth, as the majority of patients don't have historical risk factors. The development of an assay to detect cervicovaginal fetal fibronectin [fFN], proinflammatory cytokines along with transvaginal cervical length determination has greatly increased our ability to identify those patients with high risk. We performed quantitative analysis of fFN, IL-1 beta, IL-6 and IL-8 in cervicovaginal secretions by ELISA to predict preterm delivered patients with intact membrane and cervical dilatation of

Anti-inflammatory effect of omega-3 polyunsaturated fatty acids in children with bronchial asthma; relation to nuclear factor-kappa b [INF-ka B] and inflammatory cytokines IL-12 and IL-13

Asthma is one of the most common chronic inflammatory diseases of the airways .We aimed to investigate the potential antiinflammatory role of omega -3 Polyunsaturated fatty acids [omega-3 PUFA] supplementation in children with bronchial asthma in relation to the pulmonary functions, NF-ka B and cytokines [IL -12 and IL-13]. Asthmatic children [110 subjects] were divided into two groups: group A [60] supplemented with fish oil capsules containing 300 mg docosahexaenoic acid [DHA] and 700 mg eicosapentaenoic [EPA] in a dose of one capsule per day for one month, and group B [50 subjects] received placebo capsules for one month. Plasma level of DHA, NF-ka B, IL-12, IL-13 and pulmonary functions were compared between both groups before and after supplementation. The results showed that plasma DHA was increased with decrease of NF-ka B, IL- 12, IL-13, and improvement of forced vital capacity of the lungs in the supplemented group. There was a significant difference between supplemented and placebo group. Plasma DHA level was positively correlated to pulmonary function tests and negatively correlated to NF-ka B, IL-12 and IL-13. These results suggest that omega-3 PUFA supplementation is useful for treatment of asthma due to suppression of NF-ka B with subsequent decreasing production of inflammatory cytokines and improvement of pulmonary functions

Evaluation of polymerase chain reaction on amniotic fluid for diagnosis of congenital toxoplasmosis

The present study assessed sensitivity and specificity of PCR targeting P30 gene in diagnosis of congenital toxoplasmosis using amniotic fluid samples. A total of 358 pregnant women in their first trimester of pregnancy, most of them were asymptomatic while the others suffered lymphadenopathy, fever and/or malaise. The serum sample from each woman was screened for Toxoplasma-specific ELISA IgM and IgG. Sero-negative females were then screened in 2[nd] and 3[rd] trimesters for sero-conversion. Amniocentesis was performed to seropositive and sero-converted women. Detection of Toxoplasma DNA in AF was done by animal inoculation and PCR targeting P30 gene. 85/358 women were sero-positive for Toxoplasma. Congenital infection was detected in 14/85 fetuses by MI. One mouse had tachyzoite in peritoneal exudate while other 13 showed cysts in histpathological sections of mice. PCR test targeting P30 gene was positive in 13 with additional four fetuses, only PCR gave positive results, and serologic follow-up of suspected fetuses [17] by IgM ELISA confirmed congenital toxoplasmosis. Sixteen cases of congenitally infected newborn were a symptomatic. One was clinically diagnosed [ventricular dilatation] by the ultrasound. The PCR drastically changed the diagnostic repertoire for prenatal diagnosis. The sensitivity and specificity of PCR targeting P30 gene on AF samples were 92.9% and 94.4% respectively while positive predictive value [PPV] was 76.5%, and negative predictive value [NPV] was 98.5%. Its disadvantages were in fact that negative result cannot exclude acute infection, and thus must be confirmed by MI and it is also an expensive technique

impact of diabetes on pregnancy in Qatar

To investigate maternal and neonatal outcomes of pregnancies in women with different types of diabetes in Qatar. To identify factors such as age, family history of diabetes and obesity contributing to the increased risk of GD. The design of this study is retrospective. 14 pregnant women with different types of diabetes including 143 [28%] Impaired Glucose Tolerance Test [IGTT], 334[65%] Gestational Diabetes [GD], 26[5%] Insulin Dependent Diabetes Mellitus [IDDM] and 11[2%] Non Insulin Dependent Diabetes Mellitus [NIDDM] who delivered between Jan - June 2004 formed the subject of this study. Data extracted from the files included maternal characteristics, fetal and maternal complications. Eight women had abortions amid two had stillbirths, leaving a final dataset comprising 504 women [141 IGTT, 332 GDM, 21 IDDM and 10 NIDDM]. Two hundred and eighty three [56.2%] were Qatari. 53% [n=267] aged >30 years, 57.5% [n=290] had family history of diabetes, only 16.1% [n=81] treated by insulin. Polyhydramnios was the most common antenatal complication occurred in 15%[n=76]. No maternal mortality .The overall Cesarean section was 6.2% [n=31]. Preterm delivery 5.8%[n=29]. Macrosomia appeared in 7.3% [n=37] infants and congenital malformations in 2% [n=10] infants. We observed that the risk factors for GDM found in other studies are generally valid for our population. Also we found that IDDM has a poorer outcome than NIDDM. However a future prospective study is need it to draw firm conclusions regarding the relative magnitudes of the adverse effects between the different diabetic groups

Effect of toxic drug on liver function

The objective of this study was to evaluate the effect of Ivermectin on liver function of rats [Ivermectin is used as antiparasitic drug in agricultural and domestic animals.] In this study sixty adult male albino rats [150 +/- 10g] raised in a farm of General Organization of Serum and Vaccine [Helwan farm] were used. They were classified into 3 groups: Control [group I], Subacute Oral toxicity [Group H], and Subchronic Oral Toxicity [Group III]. Blood samples and Tissue samples of liver were collected. Serum aspartate amino transferase [AST] alanine amino transferase [ALT], gamma_glutamyl transferase [GGT] and alkaline phosphatase were determined. Hepatic malondiadehyde [MDA], glutathione [GSH], glutathione -5-transferease [GST] and uridine diphosphate glutamyl transferase [UDPGT] were determined. The following results were recorded: Serum AST, ALT, ALP and GGT activities were found to be significantly increased in group II and III compared with control and Alkaline phosphatase increase in group II compared to control. There was significant increase of MDA and decrease of GSH in group II and III compared with control group. Also, Ivermectin induced a significant inhibition of GST in group II and III compared with control group. However, Ivermectin caused a significant increase of UDPGT activity only in group II compared with control group. In addition, a non significant change between group II and III as observed with respect to UDPGT activity. In conclusion the present study reported that Ivermectin pesticide may have a harmful effects on liver. Further research will be done in future to investigate this hypothesis

Efficacy of certain amino acids in intervention of osteoporosis in ovariectomized rats

The aim of the current study was to evaluate the therapeutic role of some amino acids in the management of osteoporosis in ovariectomized [OVX] rats. This study was conducted on 56 adult female rats which were divided into 7 groups as follows: Gp.[1] OVX rats orally administered with [1 ml/rat/day] saline as vehicle; Gp.[2] OVX rats orally administered with L-lysine [1.26g/kg/b.wt.]; Gp.[3] OVX rats orally administered with L-arginine [500mg/kglb.wt.]; Gp.[4] OVX rats orally administered with L-glutamine [3.2g/kg/b.wt.]; Gp.[5] OVX rats orally administered with taurine [50mg/kglb.wt.] and Gp.[6] OVX rats orally administered with a combination of the four amino acids dissolved in saline. In addition, gonad-intact [control group] orally administered with 1 ml saline/rat/day was involved in the present study. The treatment was started after 3 months of ovariectomy and continued for other 3 months. Serum calcium [Ca], phosphours [P], parathyroid hormone [PTH], osteocalcin [OC], insuline like growth factor-1 [IGF-1], transforming growth factor-beta [TGF-beta] levels and bone alkaline phosphatase [BAP] activity were determined. Significant decrease in serum Ca, P levels and bone ALP activity as well as in serum OC, IGF-1 and TGF-beta levels were ovariectomy-induced, while it caused significant increase in serum PTH level when compared to their corresponding values in gonad-intact control rats. Treatment of OVX rats with L-lysine or L-arginine produced non-significant increase in serum Ca and P levels and the treatment with L-glutamine or taurine induced significant increase in serum Ca and P levels. Treatment with either one of the selected amino acids resulted in significant decrease in serum PTH level while these amino acids produced significant increase in serum osteocalcin level and BAP activity. Treatment of OVX rats with L-lysine induced non-significant increase in serum IGF-1 and TGF-beta, while the combination of L-arginine with either L-glutamine or taurine produced significant increase in serum IGF-1 and TGF-beta. Treatment of OVX rats with a combination of the selected amino acids resulted in significant increase in the all studied biochemical parameters except serum PTH level which showed significant decrease as compared to their corresponding values in OVX rats. Each of the selected amino acids or their combination significantly modulates markers of bone turnover in OVX rats. These results indicated the usefulness of these amino acids in the treatment of primary osteoporosis

Vaginal misoprostol in the management of first trimester non-viable pregnancy

To study the effectiveness of a regimen of repeated doses of vaginal misoprostol in the management of first trimester missed abortion, one hundred and four pregnant women with first trimester non-viable pregnancies were treated with an initial dose of 800 ! g of vaginal misoprostol followed after four hours by further doses of 400 ! g four-hourly for a maximum of three doses. The complete expulsion rate was 85.6%. Fifty of the 104 [48.1%] women underwent surgical evacuation. In 14 [13.5%] women, gestational products were obtained and confirmed by histopathological examination. In 36 [34.6%] there were minimal or no products obtained and these were considered to be complete miscarriages. The cervical os was found open in all [13.5%] the incomplete miscarriages. Severe abdominal pain was experienced by 10.6% of the patients and excessive vaginal bleeding occurred in 13.5% of them. A fall in hemoglobin of more than one gram/dl occurred in 5.8% of the women and another 5.8% of them had fever >38°C. The stay in hospital was two days for 87 [83.7%] women and three days for 15 [14.4%] women. One [1%] woman stayed four days and another stayed less than one day. None of the women had any complications. This study demonstrated the efficacy and safety of vaginal misoprostol as a medical treatment for first trimester non-viable pregnancies using an initial dose of 800 ! g, followed after four hours by further doses of 400 ! g four-hourly for a maximum of three doses. This management also provided adequate cervical dilatation for surgical evacuation when complete expulsion did not occur

Effect of adding cardamom, thyme and clove essential oils on some properties of white soft cheese made from goats' milk

This study aimed to improve the properties of white soft cheese made from goats' milk by adding spice essential oils at concentrations of 75 and 90 ppm cardamom, 50 and 75 ppm thyme and 40 and 60 ppm clove to goats' milk. All resultant cheeses were compared aganist that made from buffalos' milk [control I] and goats' milk [control II]. The quality of resultant cheeses was evaluated for their chemical composition, microbiological and organoleptic properties during storage at 6 +/- 1°C for 45 days. The results revealed that additives at two concentrations of essential oils insignificantly affected percentages of moisture, salt/ moisture and fat/dry matter. Moisture% significantly decreased [P

Prognostic factors for ovulatory response to letrozole in polycystic ovary syndrome

To evaluate prospectively the prognostic factors for ovulatory response to letrozole therapy in polycystic ovary syndrome [PCOS]. The IVF and Assisted Reproduction Center in Sana'a, Yemen. Thirty-three infertile patients with anovulatory PCOS were recruited. Ovulation was induced using 2.5 mg/day letrozole administered from day 3 to 7 of the cycle. When the dominant follicle reached a diameter > 18 mm, HCG 10.000 IU was given IM and timed intercourse was advised. Clinical and endocrinal parameters between responder and non-responder groups were analyzed. There was no significant difference between letrozole responders and non-responders as regards to the period and type of infertility, BMI, LH, FS H or LH/FSH ratio and E[2] levels. However, statistically significant differences were found with respect to patient age, menstrual pattern, hirsutism and fasting insulin levels between responders and non-responders to ovulation induction with letrozole in PCO patients. Response of the PCOS patients to ovulation induction by letrozole may be related to patient age, menstrual pattern, presence of hirsutism, and serum insulin levels

cautionary case of female genital mutilation

We report a case of a tightly circumcised woman who bled irregularly throughout her first year of marriage but failed to conceive. The detection and management of a large but hidden cervical polyp solved her problems. We suggest that such cases, especially in immigrant women, require deeper investigation than might at first appear to be needed

Neurotoxicity risk of repeated exposure to inhalants: potential role of melatonin and vitamin B as neuron protectors

The main objective of the current study was to elucidate the neurotoxic effects induced by repeated exposure to gasoline, perchloroethylene or toluene on male rats. The study was extended to evaluate the interventive role of melatonin, folic acid and vitamin B12 against the neurodegenerative insult produced by inhalants abuse. Ten experimental groups were assigned as follows: group [1] control group; group[2] The rats were exposed to gasoline vapors [3200 ppm] for quarter an hour / day; group [3] The rats were exposed to gasoline vapors then treated with melatonin [10 mg / kg b. wt]; group [4] The rats were exposed to gasoline vapors then treated with folic acid [200 mg / kg b. wt] and vitamin B12 [o.o4 mg / kg b.wt]; group [5] The rats were exposed to perchloroethylene vapors [800 ppm] for quarter an hour/day; group [6] The rats were exposed to perchloroethylene vapors then treated with melatonin; group [7] The rats were exposed to perchloroethylene vapors then treated with folic acid and vitamin B12; group [8]. The rats were exposed to toluene vapors [1000 ppm] for quater an hour / day; group [9] The rats were exposed to toluene vapors then treated with melatonin and group [10] The rats were exposed to toluene vapors then treated with folic acid and vitamin B12. The experiment was extended for 45 days. Brain lipid peroxidation, reduced glutathione, serotonin, dopamine, and GABA were measured. In addition, plasma total testosterone and DHEA-S were determined. Histopathological investigation of the brain tissue was also carried out. The results demonstrated that inhalation of gasoline, perchloroethylene, or toluene causes elevation of brain lipid peroxidation, GABA and plasma DHEA-S levels. However, these inhalants induced depletion of brain reduced glutathione, serotonin, dopamine as well as plasma total testosterone levels. Histopathological alterations in the brain of the rats exposed to inhalants were also observed. On the other hand, marked improvement was detected on treatment of the exposed rats with either melatonin or folic acid and vitamin B12. Melatonin supplementation exerted a better modulatory effect on the most of the measured parameters in rats exposed to gasoline than rats exposed to gasoline and treated with folic acid and vitamin B12. Rats exposed to perchloroethylene or toluene then treated with folic acid and vitamin B12 revealed more pronounced improvement in the most of biochemical parameters than that detected by melatonin treatment. Histopathological investigation of the brain revealed that the treatment of rats exposed to gasoline with melatonin produced more pronounced modulatory effect than that in case of treatment with folic acid and vitamin B12 as indicated by the appearance of healthy neurons and astrocytes. However, treatment with folic acid and vitamin B12 to rats exposed to perchloroethylene showed more curative effect than that in case of treatment with melatonin as indicated by observing the neurons more or less like control. Also, the treatment with folic acid and vitamin B12 to rats exposed to toluene showed better effect than that in case of treatment with melatonin as indicated by the appearance of the neurons as much as control, except of few neurons that appeared with some degree of degeneration. The current results clearly indicated the serious effect of inhalants on the central nervous system of rats. Treatment with melatonin or vitamin B was found to have a modulatory action against inhalant neurotoxicity

outcome of pregnancies associated with intrauterine contraceptive devices

In this retrospective study we sought to determine the outcome of pregnancies associated with intrauterine contraceptive devices. Medical records of 2000 women, who used IUCD, were reviewed in detail. All IUCDs were inserted either post menstrual, post delivery or post miscarriage. 1196 [60%] IUCDs were inserted by doctors and the remaining 804 [40%] by midwives. The cohort was divided to four groups on the basis of their age. There were 300, 950,300 and 450 women in 18-22,23-27,28-32 and 33-37 years groups respectively. They were also divided to three groups on the basis of their parity with 300 Para 1 women, 1100 Para 2-4 women and 600 Para 5 or more. 37 [1.85%] unintended pregnancies occurred, including 35 intrauterine pregnancy and 2 ectopic pregnancies. 9 [3%] of these pregnancies occurred in 18-22 year group, 16 [1.68%] in 23-27 age group, 8 [2.67%] in 28-32 age group and 4 [0.89%] in 33-37 age group [Figure 1]. 19 [1.59%] of the pregnancies occurred in women whose IUCDs were inserted by medical staff and 18 [1.51%] in those whose IUCDs were inserted by midwives. The outcome of intrauterine pregnancies included 19 [51%] term pregnancies, 9 [24%] miscarriages, no septic abortions, 7 [19%] Preterm labour including 2, 26-28 weeks and 5 29-32 weeks. No puerperal sepsis or congenital abnormalities were reported [Figure 2]

Tendon transfer around shoulder and rehabilitation in obstetric brachial plexus paralysis: clinical and computed tomographic study

109 obstetrical palsy patients with defective shoulder abduction and external rotation had subscapularis release and transfer of teres major to infraspinatus with or without pedicle transfer of the clavicular head of pectoralis major to deltoid The age at surgery averaged 67 [11-1 92] months and Follow-up averaged 36 [12-80] months. 39 cases had follow-up CT scan of both shoulders. Improvement of abduction averaged 64 0 and that of external rotation 50 0, 100% and 290% gain, respectively. Both negatively correlated with the age at surgery [p<0.001], and were significantly higher in patients operated < 4 years old. On CT scans, the degree of glenoid retroversion positively correlated [p<0. 001] with the age at surgery, and was significantly higher in patients operated >4 years old The degree of posterior subluxation showed no significant difference between different ages. There was no significant difference between the operated and normal sides in patients operated < 4 years old as regards glenoid retroversion and in those operated <2 years old as regards posterior subluxation. The operation is useful for correction of defective shoulder abduction and external rotation in obstetric palsy. It is best performed before the age of two to get maximal improvement in motion and prevent secondary bone changes. Between the ages of 2-4, it also resulted in significant improvement in motion and prevented glenoid retroversion, but not posterior subluxation. After the age of 4, the improvement in motion was not significant and secondary bone changes were not prevented

Fetal echocardiography service in Qatar: establishment, challenges and outcome

A prospective observational study at the newly established Fetal Medicine Unit Hamad Hospital, Qatar, evaluated the impact of the service on the detection rate of critical congenital heart defects, patterns of referral and subsequent yield for structural congenital heart disease in a population with a significant proportion of high risk factors. Of 391 pregnant females examined between January 2003 and December 2004, 58 [14.8 percent] had fetal cardiac abnormalities of which 23 [5.8 percent of total referrals] had major structural malformations of the heart. Cases of fetal congenital heart disease had further evaluation using real time three-dimensional echocardiography [RT3DE] which is new equipment in the paediatric cardiology department. All cases with cardiac defects whether minor or major had follow up fetal echocardiography. Neonatal echocardiography confirmed the diagnosis in all cases with major defects [100 percent specificity]. False positive cases that were found to be normal post natal were 1 percent of the total cases referred [12 percent of cases with congenital malformation]. False negative cases were 1 percent and all had a small ventricular septal defect [VSD] except for one Down's syndrome with a very large VSD. Three patients needed urgent Caesarean section [CS] deliveries, one with complete heart block [HB] and two with supraventricular tachycardia [SVT]. One patient traveled abroad as the fetus had left isomerism and major cardiac defects and complete HB. Fifteen newborns had to receive prostaglandin based on the fetal diagnosis before being seen by paediatric cardiologists. There was no termination of pregnancy due to major cardiac defects even in cases of HLHS. The preliminary results of this clinic are very satisfactory and have affected favorably the outcome of the new-borns with congenital heart defects. It is hoped that the results of this study will encourage more referrals to the FMU

Common presenting symptoms diagnosis and management of angiofibroma - a study of twenty cases

Objective: To determine common presenting symptoms, age, disease extent; and the efficacy of different surgical approaches in the diagnosis and treatment of Angiofibroma of nasopharynx

Design: All prepubertal and adolescent patients presenting with nasal obstruction, recurrent epistaxis, denasal speech, conductive deafness and anaemic look, reporting to our dept for consultancy were evaluated

Setting: Patients were diagnosed on the basis of history, clinical examination, and CT scan with contrast. Tumour excision was performed through lateral rhinotomy; lateral Rhinotomy plus Weber, Weber Fergusson and U-shaped trans palatal approaches

Subjects: Twenty patients with suggestive history, clinical examination and CT scan findings were operated for excision of tumour

Main Outcome Measures: CT scan with contrast was found most valuable investigation. Lateral rhinotomy incision was found useful for angiofibromas with extension into pterygopalatine fossa, and Weber-Fergusson approach for tumors occupying infratemporal fossa

Results: All patients were male, mean age 17.25 years. 80% presented with epistaxis, 10% with denasal speech and conductive deafness. Tumour was excised through lateral rhinotomy 8 [40%], lateral Rhinotomy plus Weber in 4 [20%]. Weber Fergusson 4[20%] and U-shaped trans palatal 4[20%]. Tumor was limited to nasopharynx [4[29%], retromaxillary space 8[40%], into pterygopalatine fossa 6[30%], and infratemporal fossa 2 [10%]. All tumors were excised completely

Conclusion: Angiofibroma of nasopharynx should be suspected in young adolescent males presenting with epistaxis or denasal speech. CT scan with contrast is the key investigation and lateral rhinotomy alone or in combination with Weber is suitable for tumours of nose, nesopharynx or more widespread