role of color duplex sonography in diagnosis of head and neck nodal masses

The diagnosis of superficial lymphadenopathy is crucial for therapeutic planning in patients with suspected malignancy. Ultrasound, CT and MRI have opened a new horizon in the evaluation of the neck including LN status. These imaging modalities have an important role in the diagnosis, characterization, and help in the treatment of neck nodal lesions. This study aims to evaluate.the role of color duplex sonography [CDS] in diagnosis and differential diagnosis of cervical LN pathology. 48 patients with persistent palpable cervical LN were included in this study. All patients were examined by CDS and CT. The final diagnosis of all examined lymph nodes was made by lymph node biopsy, fine needle aspiration cytology [FNAC], and bone marrow aspiration. The results showed. 26 reactive nodes, 5 metastatic nodes, 13 primary nodal malignancies, 3 granulomatous nodes, and 1 leukemic node. The CDS can predict the diagnosis of reactive, metastatic, NHL, and HD enlarged lymph nodes. From the results of the study we can conclude that changes in shape and internal structure as well as vascular resistance of the nodes depicted at CDS as well as the vascular pattern [intranodal angio-architecture] seem to be valuable and sensitive parameters for differentiating benign and malignant lymph nodes enlargement with 97.9% accuracy. CDS is simple, non invasive, easily tolerated by patients, inexpensive and widely available. So, it can be used as an outpatient procedure for diagnosis and follow-up of patients with cervical lymphadenopathy. In contrast CT gives an idea about location, number and nature of LN pathology but with many drawbacks such as high radiation exposure and intravenous contrast

Injection snoreplasty: a new modality in treatment of palatal snoring

Snoring continues to be a wide spread problem that affect many people and their bed partners. Snoring treatment continues to evolve to meet this demad with the emphasis on developing simpler, less invasive procedures that will minimally disrupts the patient's daily life. Surgical treatment of snoring is varied and controversial like uvulopalatopharyngoplasty [UPPP], laser assisted uvuloplasty [LAUP], cautery assisted palatal stiffening operation [CAPSO] and radiofrequency ablation [RFA] but no one procedure is widely accepted as the best procedure. Injection snoroplasty is a new procedure introduced for treatment of primary snoring. It is a simple, safe, effective, low cost and minimally invasive method with minimal complications. Fifteen patients were enrolled in this study complaining of primary snoring with respiratory disturbance index less than 10. They were collected from Al-Azhar university hospitals from July 2002 to July 2003. Preoperative assessment of the patients was done and then injection snoreplasty procedure by injecting the soft palate by sclerosing material [scleremo] to induce stiffness of the soft palate was used. Then follow up for one week was done. The overall results were 80% success. Postoperative assessment was done subjectively and objectively after 2 months. Minimal postoperative complications were noticed in the form of palatal swelling, pain, discomfort and superficial palatal mucosal breakdown which healed spontaneously with minimal treatment

Histo-pathological study of the oropharynx in snoring and obstructive sleep apnea patients

Obstructive sleep apnea [OSA] is characterized by repetitive episodes of upper airway occlusion during sleep. The purpose of this work is to study the histopathological alterations of the oropharyngeal tissues in patients with snoring and OSA. The study was carried out on two groups of patients, selected from ENT outpatients clinics of Al-Azhar University hospitals from November 2001 to June 2002. The first group, includes 30 patients, 10 snorers and 20 with OSA. They underwent uvulopalatopharyngoplasty [UPPP] and the pharyngeal specimens were taken from the distal soft palate [uvula, anterior and posterior pillars]. The second group, [control] includes 7 persons with chronic tonsillitis and underwent tonsillectomy and the control pharyngeal specimens were taken from very small parts of the anterior and posterior tonsillar pillars excised during tonsillectomy. The study revealed that obstructive sleep apnea patients were commonly obese, male, and older than the other patients. Histopathological examination showed extensive edema in the lamina propria of the distal soft palate in snorers and OSA patients and also, extensive fatty infiltration in these patients which may play a role in etiopathogenesis of OSA. There was a significant correlation between the degree of pharyngeal fatty infiltration and, the apnea index and the neck circumference but no, significant correlation with the body mass index was found. Vascular engorgement, interstitial haemorrhage, chronic inflammatory cell infiltration, and glandular hyperplasia were observed in a portion of patients with snoring and OSA, and in some controls, also lymphangectasia was found in 3 obese patients with severe OSA. So, these pathologic changes may reflect the sequel of airway obstruction rather than its cause

Role of fungal infection in cases of chronic sinusitis

This study was done on forty patients suffering from chronic sinusitis for more than six months. They were twenty eight males and twelve females, their age ranged from 20-70 years old. The main presentation was nasal obstruction, nasal discharge and headache. All patients were submitted for case history, general and local examinations, laboratory and radiological investigations. Then all patients were submitted for collection of nasal discharge by applying nasal vasoconstrictor, then each nostrile was flushed with 20 ml, of sterile normal saline. The patient takes a deep inspiration, then forcelly exhales through the nose. The collected fluid was centrifuged and sent for culture of fungi. Tissue biopsy was taken during functional endoscopic sinus surgery from the mucous membrane of the middle meatus or from the pedicle of the removed polyp. Both nasal discharge and tissue biopsy were cultured on sterile Sabaroud's dextrose agar or modified dextrose agar. The result of this study revealed four positive cases [10%]; two cases of Aspergillus flavus, one case of Penicillium and one case of Candida albicans. All patients were submitted for Functional endoscopic sinus surgery and follow up for six months revealed recurrence of one case complete cure of the other three cases