Metallic hair pin aspiration into the left tertiary bronchus

Foreign body aspiration is commonly described in infants and children. However, recently, a newhigh-risk group was identified among young women, especially those from the Muslim populationwho wear the traditional hair scarf. This is due to the habit of holding the scarf pin in between thelips to free hands to adjust the scarf more easily. Talking, laughing, or coughing while fixing thescarf may result in inadvertent inhalation of the pin into the tracheobronchial tree. We present acase of scarf pin inhalation and the challenges encountered in managing this patient during thesuccessful removal of the pin via flexible bronchoscopy under fluoroscopy guidance. This particularcase was technically challenging for us as the sharp tip of the needle was pointing upward andpiercing the bronchial mucosa.

A food bolus obstructing the oesophagus in a patient with infantile cerebral palsy

Introduction: A foreign body (FB) in the upper aerodigestive tract is a fairly common encounter.Fish bones are the commonest FB seen in adults. The commonest presentation is odynophagia.Usually, the patient will point at the level of FB on the neck to indicate the location.Methods: Clinical report.Results: This case report describes a large FB in an adult with underlying infantile cerebral palsy.Besides dysphagia, it was associated with drooling of saliva and pain in the throat region.Conclusion: FB ingestion with complete obstruction of the oesophagus is an emergency. It maycause total dysphagia as the passage of food is completely blocked.

A rare case of a sharp foreign body on the vocal cord

A foreign body (FB) in the upper aerodigestive tract is a common clinical problem that presents as as acute emergency. Sharp FB, such as fish bone or chicken bone, commonly lodges in the tonsil, base of tongue, vallecula or pyriform fossa. Dislodgement of a FB into the laryngopharynx is very rare and specifically onto the vocal cord is extremely uncommon. This case report illustrates a rare case of a sharp FB that was dislodged into the airway and stuck on to the right vocal cord, which was removed under local anaesthesia.

Tooth in the nose.

The finding of intranasal ectopic or supernumerary tooth although have been reported in the past, is still considered a rare presentation. It may remain silent for a long period of time, before manifesting with nasal symptoms. We report the case of a 33-year-old lady with an ectopic premolar tooth in the floor of her right nostril, presenting with intermittent epistaxis and foulsmelling nasal discharge. She was referred for a rhinolith in her nose. The tooth was successfully extracted via intranasal endoscopic approach.

Spinal anesthesia causing hearing loss: are we aware.

Sensorineural hearing loss can be attributed to many factors. Acoustic trauma, noisy environment, genetic syndromes, inner ear infection and tumors are the known wellestablished causes. Some of them are treatable but many of those are nonreversible. Recent literatures have shown some data that suggest this type of hearing loss also occurring post anesthesia, particularly in spinal anesthesia cases. Others claim that this hearing loss is temporary and clinically not significant.

A thyroid mass that moves with tongue protrusion: An ectopic thyroid gland

Thyroglossal duct cyst (TDC) is a developmental anomaly that usually appears in early childhood. The common presentation is midline swelling of the neck, which moves with both tongue protrusion and deglutition. Diagnosis is usually clinical and radiological. Fine needle aspiration cytology (FNAC) can be used as a tool for the exclusion of malignancy in adult patients. In some cases thyroid scan is done to rule out the presence or absence of the normal thyroid gland. A complete work-up is mandatory before cyst removal given that it contains only thyroid tissue. We report the case of a 32-year-old woman with only thyroid tissue in thyroglossal duct cyst.

Rhinolith: An important cause of foul-smelling nasal discharge

Rhinoliths result from neglected nasal foreign bodies that gradually increase in size. They are usually discovered incidentally during routine ENT examination or due to the associated symptoms such as nasal obstruction or persistent foul-smelling unilateral nasal discharge. A case of a 14-year-old girl was reported with a year history of the symptom. The foul-smelling nasal discharge noted by her mother was not the main concern to them. She was referred by her primary care physician as she complained of impacted ear wax. However, rhinolith was incidentally found upon routine clinical examination in the ENT clinic and was removed uneventfully.

Hoarseness as the sole symptom of an impending thoracic aneurysm rupture?

Unilateral vocal cord palsy secondary to thoracic aortic aneurysm is a rare occurrence. Direct compression of the enlarging thoracic aneurysm on the left recurrent laryngeal nerve causes neuronal injury of the nerve, which is manifested as hoarseness. We present a rare case of unilateral vocal cord palsy in a 60-year-old healthy gentleman caused by a large thoracic aortic aneurysm. This rare presentation, with a serious underlying pathology might be misdiagnosed or delayed. Therefore, it is important for us to have high index of suspicion in cases with a rare presentation such as this.

Antrochoanal polyp mimicking juvenile nasoangiofibroma.

Antrochoanal polyp is a benign lesion, usually arising from the maxillary sinus extending posteriorly into the nasopharynx. Typically it presents as a unilateral nasal obstruction with mucopus rhinorrhea, sleep disturbance, postnasal drip, and mouth breathers. Epistaxis is an extremely rare complaint. Unilateral nasal mass presenting in a teenage boy will increase the suspicion of juvenile nasoangiofibroma. We report a teenage with extensive unilateral nasal mass with such presentation, which later turned out to be antrochoanal polyp.

Unusual Airway Foreign Body In An 11-Year-Old Boy.

Foreign body in early pediatric life is common, owing to the child’s developing dentition and maturity of swallowing mechanism. As the child grew older, the nature of foreign body inhaled might changed. Most of them are due to carelessness and improper habit of holding foreign material in between the lips. We report a case of a boy who inhaled a soft-board metal pin, which was retrieved after multiple attempts due to the nature of the pin that easily slipped and dislodged into distal bronchioles.

Bilateral Acoustic Neuroma with underlying Neurofibromatosis Type 2: A Therapeutic Challenge.

The presence of bilateral acoustic neuroma may require modification of the usual therapeutic protocol. Preservation of hearing and total removal of the tumour is much more difficult than in sporadic unilateral lesion. This case illustrates the management of a girl with bilateral acoustic neuroma with underlying neurofibromatosis type 2.

Base of tongue as an unusual site for Non Hodgkin Lymphoma.

Background: Non Hodgkin Lymphoma (NHL) has about 3-7% of oral manifestation. Most of the lesions are from the palate, gingival, tongue, buccal mucosa, floor of the mouth and lips. These site consist approximately 2% of all extra nodal lymphomas as primary origin. The prognosis of NHL depends to the tumour stage, tumour aggressiveness and their response to treatment. The oral lesions appear to respond quite well to irradiation or chemo radiation. Methods: We present a case of a 68 year-old Malay male presented with symptoms of voice change, poor oral intake and bleeding from oral cavity, which turns out to be NHL of the base of tongue without visceral involvement.

Brain Abscess Mimicking Intracranial Extension Of Nasopharyngeal Carcinoma.

With the advent of more effective but aggressive cancer treatment regimens, survival in many types of cancer has improved including nasopharyngeal carcinoma (NPC). Radiotherapy (RT) is still the mainstay of treatment for patients with NPC. Unfortunately, it has led to several new complications of cancer and its therapy. One of the most important complications is central nervous system (CNS) infections. We report a case of NPC presented with signs of increased intracranial pressure making the diagnosis of intracranial extension of NPC. Imaging studies later on proved that it was an abscess which responded well with conservative medical treatment.

Huge hard palate and nasal septum perforation as a presentation of syphilis: A case report.

A patient presented with septal and palatal perforations imposes a diagnostic challenge because various potential causes need to be established. Therefore, elucidating the cause of the septal perforation requires obtaining a thorough history. In addition, it is very important to perform necessary investigations for the patients to determine and fix the underlying disease which cause these complaints. We report a case of patient presented with palatal and septal perforations which later was confirmed to have syphilis.

Assessment of plasma carnitine and acylcarnitine levels in preeclampsia

Objective: carnitine plays a crucial role in fatty acids oxidation. The aim of the study is to assess plasma carnitine and acylcarnitines levels in preeclamptic womedas a measure of abnormal fatty acid oxidation

Methods: the study included 40 women with preeclampsia and 30 normotensive control women in the third trimester of pregnancy. Women with multiple pregnancy, chronic hypertension, diabetes mellitus and renal diseases were excluded. Plasma levels of free carnitine and acylcarnitines were measured with high performance liquid chromatography [HPLC]

results: total and free carnitines and acylcamitines were significantly increased in preeclamptic cases in comparison to the control group. A positive correlation was found between acylcarnitines and diastolic blood pressure [r=0.382, p= 0.018]

Conclusion: the significantly high plasma carnitine concentrations found in this study supports the hypothesis of abnormal fatty acid metabolism in the pathophysiology of preeclampsia. This may contribute to the endothelial cell dysfunction of preeclarnpsia

Evaluation of the role of her-2/neu and matrix metalloproteinase-9 in breast cancer patients

The search for a simple, sensitive test to reliably determine prognosis and predict response to therapy in patients with cancer is an important area of translational research. The Her-2/neu oncogene and its receptor protein overexpression are indicators of more aggressive form of breast cancer. Her-2/neu overexpression was involved in cell differentiation, proliferation, migration and carcinogenesis. The main target of this study is to investigate the possible correlation between tissue Her-2/neu, serum Her-2/neu extracellular domain [ECD] and MMP-9. The impact of the assayed parameters on the disease free survival [DFS] in breast cancer patients will also investigated after one year of follow up. Serum was collected from 33 breast cancer patients and 10 healthy volunteers. Serum Her-2/neu ECD was detected by enzyme linked Immunosorbent assay [ELISA] and serum MMP-9 was detected by enzyme Immunoassay [EIA]. Patients were reevaluated after one year of follow up to detect disease relapse. Positive correlation between expression of Her-2/neu in the primary tumor tissue and the circulating serum Her-2/neu ECD was detected. Serum Her-2/neu ECD was more sensitive in predicting disease free survival than tissue Her-2/neu. Positive correlation between expression of Her-2/neu in the primary tumor and serum MMP-9 was also observed. In contrast, negative correlation between circulating serum Her-2/neu ECD and serum MMP-9 was detected in patients with tissue positive Her-2/neu. We also observed that MMP-9 was a good monitoring factor for the chemotherapy response. We concluded that serum Her-2/neu ECD might be a good prognostic parameter in addition to tissue Her-2/neu and MMP-9 might be the member of MMPs family that responsible for the shedding of the ECD of Her-2/neu receptor

Serum bone TRAP 5b and ICTP as prognostic markers in bone metastases from primary breast cancer

Bone is one of the earliest and most common sites for breast cancer metastasis. One-third of cancer patients will have metastases of their primary tumor to bone. The incidence ofbone metastases from primary breast cancer is approximately 13%. Bone marker measurements are noninvasive, inexpensive, and can be repeated often. Markers are derived from both cortical and trabecular bone and reflect the metabolic activity of the entire skeleton. The aim of this work was to determine serum level of Tartrate Resistant Acid Phosphatase 5b [TRAP 5b], Carboxy terminal telopeptide of type I collagen [ICTP] and CA15.3 pre-and post-operatively in patients with primary breast, cancer to asses their values as prognostic factors for the subsequent metastatic disease. Serum samples were collected from 41 females [31 patients with primary breast cancer and 10 normal healthy volunteers]. three samples were collected from patients before surgery, after 10 and 20 months from surgery. Serum TRAP 5b, ICTP a"dCA15,3 were detected by using EIA techniques. Preoperative serum ICTP concentrations >4.6ug/l [2+2SD]. were highly predictive for bone as site of metastases and higher risk of death by three times than those with preoperative serum ICTP concentrations <4.6 micro g/l While after 10 months from surgery. Bone TRAP 5b activity >5.4U/Lwas significantly correlated with poor prognosis for breast cancer and shorter 'wall survival. Serum ICTP concentrations in bone metastases sub. group, after 10 months from surgery [before reflect any Metastasis], were significantly increased from control group. Serum ICTP. TRAP'5b and CA15-3 levels were elevated in bone metastatic patients after 20 months from surgery [bone mciastases had been already diagnosed]. ICTP and TRAP 5b could be useful markers in predicting bone meiastases and might identify patients who would need uliiesorptive treatment in addition to chemotherapy.

effect of contralateral white noise on transient evoked otoacoustic emissions in different age groups

Transient evoked otoacoustic emissions [TEOAEs] can be suppressed by simultaneous contralateral sound stimulation, this suppression is mediated by the normal olivocochlear bundle. The aim of this study is to propose normative data for different age groups and gender. TEOAEs were recorded with and without contralateral white noise [WN]. The results revealed that TEOAE echo response decreased with age. Contralateral WN suppressed emission amplitude and the amount of suppression decreased significantly with increased age with a significant negative correlation between the amount of TEOAE suppression and age. The study concluded that TEOAEs recording during contralateral acoustic stimulation provide rapid, noninvasive and objective means of investigating the medial olivocochlear efferent fibers in humans

Serum insulin-like growth factor 1 [IGF-1] and its binding protein 3 [IGFBP3] in relation to estrogen in postmenopausal patients with breast cancer receiving tamoxifen with and without vitamin A

This study included 30 postmenopausal women with breast cancer stages II and III. They were divided into two groups according to the line of adjuvant treatment [tamoxifen, oral tables of 10 mg twice daily or tamoxifen with vitamin A, oral tables 200 mg daily of vitamin A] as well as 15 normal healthy postmenopausal women matched in age with the patients group. The study aimed to investigate the effect of an antioxidant [vitamin A] besides tamoxifen as an adjuvant treatment in postmenopausal females with breast cancer as a reflection of change on the serum levels of IGF-I, its binding protein 3 [IGFBP3] and estrogen which were determined by immunoradiometric assay [IRMA] and radioimmunoassay [RIA]. After six months of adjuvant treatment with tamoxifen or tamoxifen with vitamin A, a statistically significant decrease in serum IGF-I and estrogen and a statistically significant increase in serum IGFBP3 level were observed

Capillary blood flow and capillary blood glucose in fingers and toes in patients with type 2 diabetes mellitus

This study involved ten type 2 diabetic patients chosen clinically free from symptoms and signs of neuropathic foot diseases and peripheral vascular diseases [group A]; ten type 2 diabetic patients complicated with neuropathy [PN] +/- peripheral vascular disease [PVD] [group B] as well as ten healthy age-matched subjects used as controls [group C]. Full history and clinical examination, tests for microalbuminuria and glycosylated hemoglobin were done. Ankle/brachial index, laser Doppler study, capillaroscopy and capillary blood glucose for fingers and toes were done. The study concluded that the most prominent features of the early skin microvascular impairment found by laser Doppler flowmetry [LDF] in type 2 diabetes, an increase in the basal perfusion and a reduction of% of change post reactive hyperaemia [PRH] early in the course of the disease, were associated with a significantly higher capillary blood glucose in the toes of diabetic patients, either complicated or uncomplicated, when compared with their fingers