External Auditory Canal: Computed Tomography Analysis and Classification

Abstract Introduction Computed tomography (CT) details of the external auditory canal (EAC) are not fully covered in the literature, so building up base for the CT evaluation and description is important. Preoperative details of the EAC are mandatory before any approach or procedure involving the canal. Objective To determine the different dimensions, measurements, and grading of the EAC by CT scan that were not previously published. Methods The CTscans of 100 temporal bones (200 sides) were included. Axial images were acquired with multiplanar reformates to obtain delicate details in coronal and sagittal planes for all subjects. Results At the EAC entry, the mean vertical length (height) was 7.75 ± 1 mm, and its mean horizontal length (width) was 6.1 ±0.8. At the bony cartilaginous junction of the EAC, the mean vertical length was 7.88 ±1 mm, and its mean horizontal length was 6.22 ± 0.9. At the EAC isthmus, the mean vertical length was 6.8 ± 0.97 mm, and its mean horizontal length was 5.2 ± 0.76. At the medial end of the EAC, the mean vertical length was 7.1 ±0.9 mm, and its mean horizontal length was 5.4 ± 0.85. There were no reported significant differences between right and left sides in all dimensions. Males showed significantly longer vertical and horizontal dimensions of the EAC entry, vertical dimension of the isthmus, and vertical dimension of the medial end of the EAC than females. Conclusion This study improves otologists and radiologists' awareness of EAC variations in the ear field and can be of help to residents in training.

Laparoscopic varicocelectomy initial experience at al_azhar hospital [demietta]

Background: Varicocele is a collection of dilated veins in the pampiniform plexus that drain the testicle and may contribute to male infertility. A variety of surgical and non-surgical approaches have been advocated for varicocele treatment

Objective: Evaluate laparoscopic varicocelectomy with regard to intra and post-operative parameters

Patients and Methods: At Departments of urology of Al_azhar University Hospitals [Damietta]. Prospective randomized study was performed about laparoscopic varicocelectomy during the period from June 2016 to December 2017 after obtaining informed consent. The group included patients with clinically palpable varicocele confirmed by U/S complaining of infertility [primary, secondary] or chronic testicular pain

Results: The range operative bilateral Laparoscopic Varicocelectomy time was 60-90 minutes. There were no intra operative complications in the study group. The average hospital stay was 24-36 hours. Post-operative analgesics [2-3] doses, daily activities initiation usually started after 4-5days. Hydrocele formation was seen in [11.1%] patients recurrence was seen in [5.6%] patient. None of the patient has developed an atrophic testis as a result of the laparoscopic procedure. Patients had improvement of the seminal fluid parameters during follow up period and pregnancy rate was [25%]

Conclusion: Laparoscopic varicocele ligation is a simple and safe technique causing minimal morbidity and enabling rapid return to normal activity

Combined coronary artery bypass grafting and surgical resection of right atrial myxoma complicated with pulmonary embolism / Cirugía combinada de bypass de arteria coronaria y resección quirúrgica de un mixoma auricular derecho complicado por una embolia pulmonar / Chirurgia combinada de bypass da artéria coronária e ressecção cirúrgica de um mixoma auricular direito complicado por uma embolia pulmonar

Although the association between right atrial myxoma and pulmonary embolism is rare, it has been recognized for many years. This condition is fatal unless surgical intervention is performed for resection of right atrial mass and pulmonary embolectomy. A 68 years old diabetic, hypertensive male patient was admitted to our hospital with severedy spnea and chest pain. An echocardiogram and pulmonary CT angiography revealed right atrial mass and pulmonary embolism. Further more, coronary angiography was done and showed a three vessels disease. Complete surgical removal of the right atrial myxoma and parts of the tumor embolectomy from the right pulmonary artery were successfully performed combined with coronary artery bypass grafting to LAD, obtuse marginal and diagonal branches. Histological examination of the primary tumor as well as the embolus confirmed the diagnosis of benign myxoma. The patientwas discharged after 15 days of his successful operation. We report this case, as it is unique because of the rarity of the combined surgery of right atrial myxoma complicated with pulmonary embolism and coronary artery bypass grafting.

Si bien la asociación entre el mixoma auricular derecho y la embolia pulmonar es poco frecuente, se conoce su existencia desde hace años. La condición es fatal salvo si se realiza una intervención quirúrgica para la resección de la masa auricular derecha y una embolectomía pulmonar. Ingresa a nuestro hospital un paciente masculino diabético e hipertenso de 68 años con disnea severa y dolor de pecho. Un ecocardiograma y una angioTac de pulmón revelan un masa auricularderecha y una embolia pulmonar. Además, la coronario angiografia realizada identifica enfermedad en tres vasos. Se realiza con éxito la resección quirúrgica completa del mixoma auricular derecho y parte de la embolectomia tumoral de la arteria pulmonar derecha junto con un bypass de la arteria coronaria a la descendente anterior, la marginal obtusa y las ramas diagonales. El examen histopatológico del tumor primario y de la embolia confirman el diagnóstico de mixoma benigno. El paciente fue dado de alta 15 días después de la exitosa operación. Publicamos este caso ya que es único porque es poco frecuente es combinar la cirugía de un mixoma auricular derecho complicado por una embolia pulmonar con una cirugía de bypass de la arteria coronaria.

Apesar da associação entre mixoma auricular direito e embolia pulmonar ser pouco frequente, sua existência é conhecida há anos. A condição é fatal salvo se realizamos uma intervenção cirúrgica para a resecção da massa auricular direita e uma embolectomia pulmonar. Ingressa ao nosso hospital um paciente masculino diabético e hipertenso de 68 anos com dispnéia severa e dor no peito. Um ecocardiograma e um angioTAC do pulmão revelam uma massa auricular direita e uma embolia pulmonar. Além disso, a coronario angiografia realizada identifica comprometimento de três vasos. Realiza-se com êxito a resecção cirúrgica completa do mixoma auricular direito e parte da embolectomia tumoral da artéria pulmonar direita junto com um bypass da artéria coronária àdescendente anterior, a artéria obtusa marginal e os ramos diagonais. O exame histopatológico do tumor primário e da embolia confirmam o diagnóstico de mixoma benigno. O paciente recebeu alta 15 dias depois da exitosa operação. Publicamos este caso por ser único devido à pouco frequência em combinar a cirurgia de um mixoma auricular direito complicado por uma embolia pulmonar com uma cirurgia de bypass da artéria coronária.

Virtual colonoscopy-comparison with optical colonoscopy for the detection of colonic space- occupying lesions

This prospective study was performed on 20 consecutive patients with suspected or known colonic neoplasia to evaluate the sensitivity and accuracy of a new virtual colonoscopy technique for the detection of colorectal lesions in comparison with optical [conventional] colonoscopy as the standard of reference. They were 12 males and 8 females with age ranging between 48-72 years and mean age of 56.3 years. All patients were subjected to a thorough history and clinical examination, routine laboratory tests and abdominal ultrasonography. After standard bowel preparation, all patients underwent a non-contrast helical CT scan of the abdomen and pelvis followed by conventional colonoscopy in the same day. The images of CT colonography were reconstructed into a virtual colonoscopy [VC] presentation and compared with subsequent conventional colonoscopy in a blinded manner. Conventional colonoscopy identified 22 polyps 5 mm or greater in 12 patients, and no polyps were detected in 8 patients. Virtual colonoscopy correctly identified 5 polyps of 9 polyps 5-9 mm in size, and 11 of 13 lesions greater than or equal to 10 mm in diameter. Per-patient findings of VC for lesions 5-9 mm were; sensitivity 55.6%, specificity 81.8%, positive predictive value 71.4%, negative predictive value 69.2%, over all accuracy 70% and for lesions greater than or equal to 10 mm were; sensitivity 91.7%, specificity 87.5%, positive predictive value 91.7%, negative predictive value 87.5%, over all accuracy 90%. It could he concluded that VC is feasible and has excellent sensitivity and specificity for detection of colorectal lesions 10 mm and larger and provide another effective complement for the diagnosis and screening

Endoscopic repair of bilateral choanal atresia in neonates: anesthetic and surgical implications

Bilateral Choanal Atresia patients are usually in respiratory distress at birth. Such patients [neonates] have unique anesthetic and surgical requirements regarding equipment, intravenous access, fluid and drug therapy, anesthetic dosage, and environmental control. An understanding of the basic differences in physiology, pharmacologic and pharmaco-dynamic responses, and the underlying pathology of the surgical problem is essential for the development of a safe anesthetic/surgical plane. To describe and evaluate the outcome of the anesthetic / endoscopic transeptal approach for the repair of bilateral choanal atresia in neonates. A prospective analysis of a case series of neonates with bilateral choanal atresia who were treated by the endoscopic transeptal approach between July 2003 and December 2005 was undertaken. Endotracheal intubation was performed under adequate plane of general [inhalational/narcotic] anesthesia. Adequate depth of general [inhalational/narcotic] anesthesia with spontaneous and gentelly assisted ventilation were appropriate till the end of surgery. The endoscopic approach was performed using 4-mm 0° telescope. A laterally based trapezoid shaped septal mucosal flap was created on each side using a radiofrequency needle. The flaps were elevated in a swinging door fashion to expose the atretic plate and the vomer. After removal of the posterior bony septum and widening of the choana, the flaps were trimmed and applied to the exposed lateral bony rim of the choana. All patients were stented bilaterally for three to four weeks postoperatively. Neonatal/infant Pain Scale [NIPS] was used to assess the wellbeing and pain status of neonates in the immediate postoperative period. The study group included 14 neonates aged 2 to 25 days at the time of surgery. Follow up ranged from 4 to 36 months with a mean of 17.3 +/- 9.3 months. All neonates had a smooth anesthesia course, with minimal blood loss. Postoperatively, all have 0 to 1 score in the NIPS. Recovery was uneventful in all cases except for one case that developed bleeding in the immediate postoperative period and was controlled under endoscopic guidance. One case died three months following stent removal from uncompensated heart failure due to concomitant ventricular septal defect. An adequate functional nasal breathing and appropriate feeding with sufficient weight gain were maintained during the entire follow-up period. The described anesthetic/endoscopic technique was very adequate. It offered excellent visualization of the choana and allowed maximal widening of the choana while preserving the mucosa along the entire circumference of the newly created choana and hence less risk of postoperative stenosis

Study of the fate of detectable left atrial thrombi at repeated tranesophagealechocardiography in patients with mitral stenosis

Previous studies did not encourage balloon mitral valvuloplasty [BMV] when left atrial and /or LAA thrombi are present. Patients with LA and/or LAA thrombi are considered at high risk for thromboembolic events. So it is considered a major cause of morbidity and mortality in patients with mitral stnosis. To investigate the fate and stability of LA and/or LAA thrombi under the effect of oral anticoagulation this study included thirty patients with mitral stenosis having LA and/or LAA thrombi detected by TEE. They were subjected to full anticoagulation therapy controlled by INR of 2-3. Repeated TEE were done three and six months later. According to the results of this study the patients were grouped into two main groups: Group 1: included sixteen patients who had dissolved LA or LAA thrombi after anticoagulation therapy. It represented [53.33%] of all cases included in this study. In thirteen patients out of all the total sixteen patients representing group I, the thrombi were dissolved after three months therapy as they had clear LA and LAA in the second TEE study. They represented [81.25%] of group I and [43.33%] of all patients included in this study. In three patients the thrombi were dissolved after six month anticoagulation therapy, they represented [18.75%] of group I and [10%] of the whole patients included in this study. Group II: which included eleven patients [36.66%] all of them had non dissolved thrombi in LA and LAA in spite of six months anticoagulation therapy, three patients were excluded from the study. In conclusion: Complete resolution of LA and/or LAA thrombi occurs in a considerable number of patients [53.33%]. Age of the patients, size of the left atrium and size of LAA or LAA thrombi are considered the only significant factors influencing thrombus resolution. No other clinical or echocardiographic parameters could influence thrombus resolution. Majority of LA andyor LAA thrombi dissolve in the first three months with less incidence of resolution in the next months

Paranasal mucoceles: usual and unusual

The aim of this study was to review the usual and unusual aspects regarding the clinical presentation, diagnosis, and treatment of paranasal sinus mucoceles. Special emphasis was given to the role of endoscopic marsupialization either alone or in combination with a limited external procedure in creating a functioning epithelialized pathway between the mucocele and the sinonasal cavity. The medical records of all patients with mucoceles who were treated by the author over a five-year period were reviewed. There were 37 mucoceles, including 12 frontoethmoidal, 11 sphenoidal/sphenoethmoidal, 7 maxillary and 7 lesions arising from aberrant locations within the sinonasal complex. CT scan was the initial diagnostic modality in all patients. In ten patients, MRI was carried out to confirm the diagnosis. Endoscopic marsupialization was the only surgical modality in 32 patients. Four patients underwent surgery via combined endoscopic and limited external approach. Recurrence was reported in one patient 6 months following endoscopic marsupialization of sphenoid mucocele. Postoperative endoscopic examination showed a widely patent healed opening in 33 cases and asymptomatic cicatricial narrowing in 2 cases. The author concluded that well-planned simple or extended endoscopic technique either alone or in combination with a limited external procedure is uniquely suited to the management of virtually all mucoceles

Endoscopic coagulation of sphenopalatine neurovascular bundle for intractable allergic rhinitis: a histopathological study

Manifestations of allergic rhinitis are due to a primary immunologic response which leads to a battery of neurovascular reactions. The sphenopalatine foramen [SPF] transmits both the blood and nerve supply to and from the nasal mucosa. We aimed at controlling the allergic reaction by endoscopically coagulating the neurovascular bundle at the SPF. The results were evaluated in patients with intractable allergic rhinitis by comparing the histopathological changes in biopsy specimens from the middle turbinate on the operated sides with control biopsies from the unoperated sides both at 1 month and at 2 years postoperatively. Qualitative and morphometric quantitative histopathological evaluation of the middle turbinate mucosa showed dramatic diminution of the mucosal reactivity and inflammatory cellular infiltrate compared with the control levels at one month postoperatively: At 2 years postoperatively, there is a gradual weaning of these effects Endoscopic coagulation of the sphenopalatine neurovascular bundle is a minimally invasive technique that seems promising in controlling intractable allergic rhinitis that fails to respond to medical treatment

Ranula and the sublingual salivary glands review of 32 cases

Comparative study to evaluate various surgical methods for the treatment of ranula. Thirty two patients were retrospectively studied regarding treatment method namely, excision of the ranula, marsupialization, excision of the ranula combined with sublingual gland removal, recurrence and complications. All available specimens were histologically studied. There were 25 female and 7 male patients. The mean age was 13.5 years. Six patients had ranula excision, 4 had marsupialization and 22 had excision of the ranula combined with sublingual gland removal. These treatment methods showed 18.7%, 80% and 0% recurrence rate respectively. There was no complication with any method employed. The most reliable method for eradicating ranula of the floor of the mouth is by surgical excision of the ranula with the sublingual gland removal