Occult otologic fistulas as a cause of recurrent meningitis

Occult perilymph fistulas may be the cause of unexplained non-epidemic meningitis. This paper reviews the case reports of 5 patients [3 females and 2 males aged 4-56] presenting with unexplained meningitis. All had sensorineural hearing loss of variable duration. All patients were submitted to CT, MRI and MRI cisternography. All underwent exploratory tympanotomy to seal the fistula. In all patients the fistula could be located and sealed. All had no further attacks of meningitis and those who had serviceable hearing did not show any further deterioration. In any case of recurrent meningitis an occult perilymph leak should be sought. A high degree of suspicion should exist if there are auditory or vestibular symptoms. Detecting and sealing of the defect will protect the patient against further attacks and deterioration of hearing. Keywords: perilymph fistula, meningitis, exploratory tympanotomy

Extracranial meningiomas

Extrcranial meningiomas involving nose, paranasal sinuses, orbit and neck are uncommon. This series describes the clinical presentations, radiographic findings, and implications for surgical treatment of extractranial meningiomas. Egypt patients [median age 41.8 years] underwent resection of extractranial meningioma. In five cases [62.5%] meningioma extended to adjacent structures and the surgical approach for resection is tailored according to the extension. Preoperative neuroradiologic imaging is crucial for preoperative and postoperative evaluation of cases. Preoperative radiographic assessment showed meningioma associated with anterior cranial fossa erosion in one case [12.5%], cavernous sinus involvement and clival erosion in one case [12.5%], and olfactory groove erosion in one case [12.5%]. Histological examination of the bones from anterior cranial fossa and clivus were positive in two cases [25%]. Meningioma extended to the nasopharynx, invading the mucosa in one patient and another one patient suffered from orbital involvement and extension to optic nerve. Understanding the pertinent clinical and morphological aspects of extracranial meningioma is essential to surgical treatment of patients with this condition

Prognostic value of telomerase and DNA ploidy in laryngeal carcinoma

Prognosis of carcinoma of the larynx is currently based on the morphologic analysis of the tumor extent, differentiation -grading and type of microscopic invasion. The DNA ploidy status and the cell proliferation activity may give complementary information about the prognosis. Telomerase may be used as a measure of tumor proliferation. The aim of this work is to investigate the probable application of telomerase as measure of cell immortalization as well as DNA ploidy as a measure of cell proliferation in prognosis of patients with laryngeal carcinoma. The work was carried out as a prospective observational study that included 35 patients with laryngeal carcinoma who were treated surgically at Ain Shams University Hospitals, Cairo, Egypt. Flowcytometric analysis and biochemical assay of telomerase, using human Telomerase Reverse Transcriptase [hTERT] mRNA assay by RT-PCR, in resected specimens were done. The proliferative indices in different parts of the tumor were found to be significantly different from each other, with those of tumor edges being the highest. The ploidy status at the edge of the tumor was significantly different between surviving and non-surviving patients, while the tumor core proliferative index was found to be significantly lower in patients without recurrence than those with recurrence. Agradient of telomerase levels was noticed. with levels from tumor cores being highest followed by tumor edges, resection margins and least levels in lymph nodes. Multivariate analysis showed hTERT levels in tumor edges to significantly affect survival. Both Flowcytometric parameters and telomerase activity may be useful as a prognostic factor for survival in patients with laryngeal carcinoma. Telomerase activity may be used for biologic demarcation for conservational laryngeal surgery, as well as a 'spectral' marker

Acoustic rhinometric study of the nasal cycle in tracheostomized and laryngectomized patients

This study was performed on 13 postoperative tracheostomized cases, 11 postoperative laryngectomized patients and 10 control subjects. Acoustic rhinometry was used to determine minimum nasal cross- sectional area and nasal cavity volume as indices of nasal patency. Testing was repeated at an interval of 30 minutes over a period of 3-8 hours. The results demonstrated that there was normal cyclical fluctuations in nasal patency after airflow deprivation by tracheostomy and laryngectomy albeit of lower amplitude than normal. Different patterns were recorded with an irregular pattern being the most frequent pointing to crucial role of peripheral receptors on central controlling mechanism. The cycles tended towards normality sometimes after surgery. This interval was longer after laryngectomy compared with only tracheostomy indicating that even minimal airflow through the nose may be enough to stimulate nasal receptors and reestablish a trend towards normality