Functional outcome after swenson's operation for hirshsprung's disease

Hirschsprung's disease [HD] is one of the most common causes resulting in lower intestinal obstruction in children with atypical clinical symptoms and inconspicuous morphological findings by barium enema X-ray. Recently, this situation has been largely ameliorated by improvement of instrument for measurement of anorectal pressure. By now, anorectal manometry has been regarded as a routine means for functional assessment and diagnosis of HD. It is accurate in nearly all cases of HD with characteristic absence of rectoanal inhibitory reflex. Different surgical modalities of treatment are available and Swenson's operation is one of the surgical procedures done for HD. Anorectal manometric findings may change after Swenson's operation with improvement of rectoanal inhibitory reflex in some cases. We aimed to evaluate functional results after Swenson's operation for HD using anorectal manometry. Between 1996 and 2005, 52 patients were diagnosed with HD and operated upon by Swenson's operation in Gastroenterology Center, Mansoura University. There were 33 males [63.46%] and 19 females [36.54%] with a mean age of 3.29 +/- 1.6, [range 2-17 years]. Anorectal manometry and rectal muscle biopsy were done preoperatively for diagnosis but after operation anorectal manometry was done after every six months and then yearly. All of the 52 patients showed absent rectoanal inhibitory reflex on manometric study with relatively higher resting anal canal pressure and within normal squeeze pressure. Postoperatively, there were 35 continent patients [67.31%] with 11 patients [21.15%] showing minor incontinence and six [11.54%] with major incontinence. On the other side, there were five patients [9.62%] with persistent constipation after operation [three due to anal stricture and two due to residual aganglionosis]. Postoperative manometric study showed some improvement in anal sensation with the rectoanal inhibitory reflex becoming intact in six patients [11.54%] four years after operation. Anorectal manometry is a more reliable method for diagnosis of HD than barium enema X-ray but for final diagnosis, it is reasonable to combine anorectal manometry with tissue biopsy. Functional outcome after Swenson's operation for HD may improve in some patients complaining of incontinence or constipation. Anorectal manometry may show improvement of the parameters after Swenson's operation

role of minimally invasive surgery in treating nasal symptoms in patients with long lasting allergic rhinitis

Allergic rhinitis is a common condition, affecting about 10-20% of the population. The main symptoms are nasal obstruction, rhinorhea and hyposmia. The treatment is mainly conservative and consists of use of antihistamins, nasal corticosteroid or both. Despite the effectiveness of the medical treatment, permanent nasal changes like mucosal hypetrohy of the inferior turbinates and nasal polyposis occur in many patients with time. In such cases surgery, in addition to the medical treatment, is indicated. The role of the surgery is: 1/ to reduce the volume of the inferior turbinates: 2/to remove nasal polyposis: 3/ to facilitate the ventilation of the paranasal sinuses by enlarging their openings and 4/ to create better conditions for penetration of local steroids into the nasal mucosa. Minimally invasive surgery was performed in 65 patients with allergic rhiniris. Thirty seven of them were male and 28 female, aged from 15 to 64 years. All the patients underwent nasal endoscopy and the pathological changes were classified into 3 groups: 1/mucosal hypertrophy in 45 cases; 2/nasal polyosis in 8 cases or 3/ both in 12 cases. The preoperative and postoperative assessment of nasal function was measured by: 1/visual analog scale [VAS]; 2/ acoustic rhinometry; 3/ rhinomanometry. Surgery consisted of: 1/endoscopic turbinoplasty in 57 case; 2/ polypectomy alone in 7 cases or 3/ polypectomy, combined with infundibulotomy, anterior ethmoidectomy and middle meatus antrostomy in 13 cases. In addition, in cases with marked septal deviations, 7 septoplasties were done. The results of the surgery were evaluated 6 months to ' year after the operation and show marked improvement of the main complains: obstruction, rhinorhea and hyposmia. The following conclusions were made: 1/Minimally invasive nasal surgery is effective in treating the main symptoms of allergic rhinitis. It brings long lasting relieve from the nasal obstruction, nasal secretion and anosmia, 2/By destructing the submucosal blood vessels and hypertrophic glands and maintining the patency and the ventilation of the paranasal sinuses, minimally invasive surgery acts as pathogenic treatment of allergic rhinitis. 3/The use of endoscopes, operating microscope and powered instruments, enhance the results of the surgery. 4/Minimally invasive surgery is a complementary treatment of allergic rhinitis and does not substitute the medical treatment

Voice quality in patients with bilateral vocal cord paralysis before and after surgical treatment

Voice quality in bilateral vocal cord paralysis [BVCP] is usually fair, but breathing is severely impaired. Treatment is directed towards widening of the glottis by using different endoscopic surgical methods. As a results of the surgery the voice becomes worse. In an attempt to evaluate the effect of surgical treatment on voice quality and trying to find the best compromise between breathing and phonation, we used objective voice analysis in 15 patients before and after surgery. Ten of them were treated by CO[2] laser posterior cordectomy and 5 by laser arytenoidcordectomy. All patients were decannulated 1 months after treatment. Phonetography, sonagraphy and computed voice analysis were used for evaluation of phonatory function. Six parameters of the basic tone were messured. In all 15 patients impairment of the voice quality was found. The voice was worse in the patients who underwent arytenoidcordectomy compared to those treated by posterior cordectomy. Concerning voice quality posterior cordectomy should be used with preference in the treatment of BVCP. Arytenoidcordectomy should be used in cases with arytenoids fixation or small and narrow larynx

Evaluation of the efficacy of budesonide [Neo-rinactive] in treatment of perennial allergic rhinitis monitored by acoustic rhinometry

Treatment of perennial rhinitis with nasal corticosteroids is common practice and Budesonide is one of the most appropriate drugs in this field. The topically applied Budesonide [Neo-Rinactive] was used in the treatment of 30 patients with perennial allergic rhinitis. The patients received 400 micro g Budesonide intranasally twice daily for a period of 4 weeks. The efficacy of treatment; nasal symptoms and the local side effects were estimated through a 4 point scale: 0-absent; 1-mild; 2-moderate; 3-pronounced. In all patients nasal patency before and after treatment was monitored by acoustic rhinometry. The results of our study showed significant improvement of nasal patency, reduction of nasal symptoms, especially of the nasal obstruction and rhinorrhea. Only 3 patients reported for dry nose and crust formation. Intranasal inhalations with Neo-Rinactive proved to be effective with only a few side effects and could be used in the treatment of perennial allergic rhinitis. Acoustic rhinometry is accurate and objective method for evaluation of the intranasal geometry and also for monitoring of the treatment results

Mast cells in polyps of the vocal folds [Vocal cords]: a clinicopathological study

This study was carried out on 30 surgically excised polyps of the vocal folds. Sections from each polyp were stained with hematoxylin and eosin as well as toluidine blue pH 4. The same stains, were applied to sections from 5 control specimens. In 22 polyps, the mean number of mast cells/high power field was 0-4. Similar to control specimens, but in 8 polyps [26.7%] the mean count of mast cells/high power field was high. Eosinophils were detected in 25% of the polyps with high counts of mast cells and marked oedema was observed in 50% of these polyps. The results of the present study suggested that hypersensitivity reactions may play a role in the pathogenesis of at least some of the vocal fold polyps. A trial of medication with antiallergic drugs suggested before surgery is decided

Acoustical changes in radical ear surgery

The external ear acts as a resonant system that adds about 12 dB at frequency around 2000 Hz at the tympanic membrane which helps to reduce the loss of acoustic energy around that frequency. 60 ears [33 had radical cavities and 27 were normal] were examined, and the frequency resonance curve was recorded. It is found that radical mastoid cavities have resonant frequency at 4.28 KHz compared to 1.95 KHz in normal ears. It is concluded that radical mastoid surgery favors higher speech frequencies which are important for speech intelligibility, while intact canal wall technique [acts as normal ear] favors less important lower frequencies

Pitfalls in diagnosis and treatment of parotid gland tumours

A head and neck surgeon dealing with parotid neoplasia feels his steps with considerable caution. This study presents abnormal situations, where some parotid swellings were misdiagnosed or their management entailed more experienced surgical skill. Fifteen patients were described, one was suffering from possible occult neoplasm, one from lymphoma of the parotid and three patients had paragangliomas related to the gland. The remaining ten patients had extensive malignant swelling, where the overlying skin and the mandibular ramus were involved by neoplasm