Navigated intraoperative ultrasonography for brain tumors: a pictorial essay on the technique, its utility, and its benefits in neuro-oncology

Intraoperative imaging has become one of the most important adjuncts in neurosurgery, especially in the surgical treatment of intra-axial tumors. Navigation and intraoperative magnetic resonance imaging have limitations, and intraoperative ultrasonography (IOUS) has emerged as a versatile and multifaceted alternative. With technological advances in ultrasound scanners and newer multifunctional probes, the potential of IOUS is increasingly being utilized in the resection of tumors. The addition of image guidance to IOUS has exponentially increased the power of this technique. Navigated ultrasonography (nUS) can now overcome many of the limitations of conventional standalone two-dimensional ultrasonography. In this pictorial essay, we outline our nUS technique (both two- and three-dimensional) for the resection of intra-axial tumors with illustrated examples highlighting the various steps and corresponding benefits of the technique.

Early hearing aid fitting - key to better education for school going special children with hearing impairment

INTRODUCTION: 10% of the world population has hearing impairment. The most common association for this neurological impairment is considered to be consanguineous marriages. Our study aim is to find the Impact of late advice and fitting of hearing aid on the level of schooling of special children and the rate at which consanguinity is related to congenital hearing loss

MATERIALS and METHODS: This is a cross sectional survey conducted on special children participating in a free ENT examination camp conducted for the special children. 50 children with hearing impairment as the single disability were selected for the questionnaire based survey

RESULTS: Fifty six percent children were fitted with hearing aid at the ages of 1-2 years, only twelve percent [6 participants] were able to communicate verbally; this is when speech therapy was also received along with a hearing aid. This had a p-value of 0.001. They also had the most age appropriate school years.Thirty eight of the participants gave a history of consanguineous marriage which is seventy six percent

CONCLUSION: The children who had the diagnostic workup completed and hearing aid fitted at 2-4 years, not only did well in developing verbal communication. They also did better at school

Another important factor in speech development is speech therapy after the fitting of Hearing Aid. Without speech therapy the maximum benefit cannot be achieved from the hearing aid device

The frequency of hearing impairment being associated with consanguineous marriage in our study is seventy six percent which is even higher than the regional figures for this problem

Presentation, management and outcome of surgery PF thyroid swellings by ENT and head and neck surgeons at civil hospital Karachi

Objective: to assess the presentation, management and outcome of surgery of thyroid swellings

Design: retrospective study

Place and duration of study: department of Otorhinolaryngology-Head and Neck Surgery, Dow Medical College and Civil Hospital Karachi [CHK], from Jan 2004 to June 2010

Patients and methods: retrospective review of 184 consecutive cases of thyroid swellings admitted and operated, irrespective of age, sex and socioeconomic status. Physiological goiter and previously operated thyroid swellings were excluded from the study. Demographic data, clinical features, investigations, surgical management details and complications were assessed

Result: among 184 cases of thyroid swellings 62.5% were between 21 to 40 years of age, with female preponderance [79.9%]. Majority [71.7%] cases belonged to lower socioeconomic status. Right lobe was involved in 32.60%, left in 15.7% while both lobes were involved in 51.5% cases. Multinodular goiter was seen in 54.8% cases while 39.1% cases had solitary nodule. Total thyroidectomy was performed in 23.3% cases, near total thyroidectomy in 9.8%, subtotal thyroidectomy in 31% and lobectomy [with isthemectomy] in 35.9% cases. In postoperative period, hoarseness was seen in 0.5% cases; while other complications like bleeding due to slipping of ligature, wound infection and hypoparathyroidism was seen in 1.6%, 2.2% and 2.2% cases respectively

Conclusion: with female preponderance and low socioeconomic status, thyroid swellings are mostly seen between the ages of 21 to 40 years. Solitary nodule and multinodular goiter are common findings. Surgical management performed by ENT - Head and Neck surgeon's ranges from total thyroidectomy to lobectomy, gives good results and few complications

Outcome of tympanoplasty type - I by underlay technique

Objective: to observe the factors influencing the success of type-I tympanoplasty by underlay technique, in closing tympanic membrane perforation of variable size and location with temporalis fascia graft

Design: prospective study

Place and duration of study: department of Otorhinolaryngology, Head and Neck Surgery, Jinnah Postgraduate Medical Centre, Karachi from April 2004 to November 2006

Patient and methods: hundred [100] consecutive patients of dry tympanic membrane perforation undergoing type-I tympanoplasty were included. Specific inclusion and exclusion criteria were set. Data were collected regarding age, gender, cause, site and size of tympanic membrane perforation, pre and postoperative audiogram results. The data were entered in a set performa and was analyzed using SPSS version 14.0

Results: the male: female ratio was 2:3 with age varying from 18 to 40 years [mean age 31.2]. Overall success rate was 81% [81 out of 100 perforations closed successfully]. There was no significant effect of age, gender and size of perforation on closure. All patients with traumatic perforation had successful closure [100% with a p-value of <0.05]. Out of the 100 patients tested, the mean air conduction threshold was 40db preoperatively and 28 db postoperatively, while the mean bone conduction threshold remained the same pre and postoperatively i.e. 15 db. On postoperative audiometric analysis air bone gap closed completely in 4 patients, 51 ears had a postoperative air-bone gap of 10 db or less, reduced up to 15db in 26 patients, while in the remaining 19 ears there was no uptake of graft

Conclusion: underlay technique for type-I tympanoplasty is an effective method for closure of uncomplicated tympanic membrane perforations. Patients with a traumatic perforation have a high success rate. Postoperatively these patients have record improvement in hearing on pure tone audiogram