Endoscopic transnasal dacryocystorhinostomy: our experience and case series analysis

Background: This study aims to describe our surgical technique and results for endoscopic transnasal dacryocystorhinostomy for the blocked nasolacrimal passage in patients presented in the department of Otolaryngology and ophthalmology at a tertiary care center

Methods: A consecutively presenting case series of blocked nasolacrimal passage were selected for transnasal endoscopic dacryocystorhinostomy. Bone removal done by cold instruments and the drill was used to remove the bone over the superior aspect of the sac. Medial wall of the sac was removed to marsupialize the sac in the nasal cavity. Septoplasty was done in 13 patients [17.10 %]. The specific surgical approach with or without septoplasty and the use of endolight was discussed. Postoperative follow up including endoscopic examination and results are documented

Results: A total of 76 cases were included. Mean age was 37.32 [range 6-76]]. An endolight was used in all cases to localize the site of nasolacrimal sac72 cases [94.74 %] have successful outcome in terms of relief of symptoms, whereas 4[5.26 %] cases had persistent epiphora. Revision procedure were done and 3[3/4, 75 %] cases had successful outcome. The overall success rate in our series of primary and revision ETDCR is 98.68 %

Conclusion: Endoscopic transnasal dacryocystorhinostomy is an effective treatment for nasolacrimal duct obstruction. Use of the endolight to localize and the power drill to expose the sac and septoplasty; contribute to the ultimate surgical success

Presentation and management of parathyroid tumors

Objective: To evaluate cases presenting with parathyroid tumors and the efficacy of treatments offered

Methods: Six cases presented with bony manifestations in mandible, femur, tibia and maxilla while one presented with an overt neck swelling. Renal calculi showed in one case. All cases were subjected to assessment of serum parathyroid hormone level and radionuleotide scan.Sonography was done in addition in two of the cases . In all cases parathyroid tumors were identified and subjected to exploratory parathyroid surgery, In addition bony pathologies were subjected to excisions of the lesions

Results: In all the cases serum parathyroid hormone levels were raised.MIBI scans picked parathyroid tumors in almost all the cases. Six of the excised tumors were parathyroid adenomas while one was adenocarcinoma. Additional surgeries done in these cases include excisions of mandibular growths, maxillectomy and osteotomies on tibia and femur. All were giant cell tumours.One case with adenocarcinoma expired. The other cases showed normalization of parathyroid hormone levels

Conclusion: Parathyroid adenoma is the common benign tumor of parathyroid gland usually presenting with exaggerated parathyroid hormone levels. Ultrasound scan screening with tc99 Sestamibi scanning are most helpful in establishing the diagnosis. Parathyroid surgery is safe in experienced hands and is the standard treatment modality to reverse the morbidity associated with pathologies. In all bony lesions with a doubtful clinical diagnosis screening for Parathyroid lesions is mandatory. Gross disfigurements, functional disabilities call for excision of bony lesions

Cotton bud for ears - friend or foe?

To study the causes and to evaluate the impact of using cotton bud in the ear in a cross section of population in Karachi. 100 consecutive cases who reported with complaints after using cotton buds for varying durations were selected at the keamari campus of Ziauddin Hospital over aperied of nine months. The ones with active suppurative disease were excluded. Queries were made about the mode and the motives for using cotton buds. Their complaints were registered in detail. They were all subjected to examination for ear with otoscope. A few were examined with microscope. Tuning fork test were done in all the cases. Observations were recorded on a proforma. Prospective observational. January 2007 to November 2007. Majority of cotton bud users belonged to the 11 to 30 years age group and reported usage for months. Among the reported complaints itching and pain dominated followed by feeling of fullness, discharge and hearing impairment. Tenderness of the pinna was observed, while oederna and erythema was the dominant finding [along the external meatus, followed by discharge and skin cracking. Otomycosis was definitely found in 13 cases while foreign bodies [pencil leads and rubber pieces] were detected in the under 10 years age group users. Wax was found in only 4 meati. 44 of the meati did not show any abnormal feature. Tympanic membrane showed perforations of various sizes in 4 of the cases. Hearing was impaired in 30 cases. Use of cotton bud is harmful and unsafe. Awareness about the causes of itching is vital and always necessitates an ear examination. Public knowledge about the possible hazards of using cotton buds should be dispersed on the media

Giant cell tumours of the maxilla and tibia presenting concurrently as an initial manifestation of primary parathyroid adenoma

A 14 years female of Afghan origin reported with maxillofacial and tibia growths causing progressive deformities since nine months, both were giant cell tumours on histopathology. Serum calcium was normal, but the parathyroid hormone was exaggerated [678pg/ml]. Ultrasound indicated and Tc-99m Setamibi scan confirmed a left lower parathyroid lesion. A 4cm length mass was identified, removed and proved to be a parathyroid adenoma. Two weeks later a subtotal maxillectomy and six weeks later anterior wedge osteotomy of the tibia were carried out. Serum parathyroid hormone level normalized