A makeshift blue light filter for endoscopic identification of traumatic cerebrospinal fluid leak using fluorescein

Objective@#To describe a makeshift blue light filter for endoscopic visualization of a traumatic cerebrospinal fluid leak repair using intrathecal fluorescein and its application in one patient.@*Methods@# Study Design:Surgical Instrumentation Setting:Tertiary Government Training Hospital Patient:One @*Results@#Intra-operative endoscopic identification of fistulae sites was achieved using intrathecal injection of fluorescein that fluoresced using our makeshift blue light filter in a 43-year-old man who presented with a 3-month history of rhinorrhea due to skull base fractures along with multiple facial and upper extremity fractures he sustained after a fall from a standing height of 6 feet. He underwent transnasal endoscopic repair of cerebrospinal fluid fistulae in the planum sphenoidale, clivus and sellar floor. Post-operatively, there was complete resolution of rhinorrhea with no complications noted. @*Conclusion@#Our makeshift blue light filter made from readily available materials may be useful for endoscopic identification of CSF leaks using fluorescein in a low- to middle-income country setting like ours.

Blindness from fungal rhinosinusitis of the paranasal sinuses: A case report

@#Objective: To present a unique case of blindness resulting from fungal rhinosinusitis involving multiple sinuses mimicking a malignant process in a pregnant patient. Methods: Design: Case Report Setting: Tertiary Government Training Hospital Patient: One Result: A 36-year-old pregnant woman developed unilateral blindness during her 20th week of gestation with a history of binocular diplopia, unilateral nasal obstruction and anosmia for 13 months during the pre-pregnancy period. Sphenoid sinus malignancy was suspected on imaging. The planned biopsy was intraoperatively shifted to endoscopic sinus surgery when clay-like materials were seen involving the left maxillary sinus and bilateral sphenoid and ethmoid sinuses. Histopathologic examination confirmed fungal growth. Postoperatively, nasal symptoms resolved but blindness of the left eye and blurring of vision of the right eye persisted. Conclusion: Fungal rhinosinusitis rarely occurs in multiple sinuses and is commonly misdiagnosed. It can afflict pregnant patients and mimic a malignant process. A high index of suspicion early on, especially in the presence of nasal congestion and diplopia may prevent potentially irreversible complications.

Spontaneous passage of ingested coin in children

@#<p><strong>OBJECTIVES:</strong> To determine the factors related to spontaneous passage of ingested coins in children.<br /><br /><strong>METHODS:</strong><br /><strong>Design:</strong> Retrospective study<br /><br /><strong>Setting: </strong>Tertiary Government Hospital<br /><br /><strong>Subjects: </strong>The records of 136 pediatric patients with a history of coin ingestion seen at the emergency room department of our institution between December  2012 and May 2014 were retrospectively reviewed. Demographic data such as age and gender of the patient were recorded, including the type of coin, location of coin in the esophagus, time of ingestion and time of spontaneous passage into the stomach (for those that passed spontaneously).<br /><br /><strong>RESULTS:</strong> Spontaneous passage in 27 out of 136 pediatric patients with radiographic evidence of a round radio-opaque foreign body initially located in the esophagus eventually passed into the stomach or intestines, accounting for 20% of the total number of cases. Coin ingestion was more common in patients aged 5 to 6 years (33% of cases), with slight male predominance (58%). One peso coins were the most common type of coin ingested, however only 24% of these spontaneously passed. The rate of spontaneous passage was highest in smaller sized coins (5 and 25 centavo coin) compared to larger sized coins (5 peso). Proximally located coins, albeit more common than middle and distally located coins, were the least likely to spontaneously pass (12%). Average time interval from ingestion to passage of the coin was 12 hours.<br /><br /><strong>CONCLUSION:</strong> Many factors are related to spontaneous passage of foreign bodies in the esophagus. The age of the patient, type of coin ingested, and initial location of the coin in the esophagus should be considered. Older patients, smaller sized coins, and distally located coins have the highest probability of spontaneous passage beyond the esophagus. A 12-hour observation period may be considered in patients with single esophageal coin ingestion.</p>