Causes of unilateral proptosis and its management

To evaluate the common ENT diseases causing proptosis. A retrospective analysis. Department of ENT and Head and Neck Surgery Civil Hospital and Jinnah Postgraduate Medical Centre Karachi [JPMC] during September 1995 to September 1998. This study is based on 25 patients admitted in the ENT dept. of Civil Hospital and JPMC Karachi during the period of three years. RESULTS: Out of25 cases 15 were female and 10 were males of 13 to 62 years of ages carrying different pat hologies e.g 8 cases of fungal sinusitis, 6 of nasal polyps, 2 of inverted papilloma, 2 cases of carcinoma maxilla, 3 of carcinoma ethmoid sinus, 2 of angio fibroma, one case of mucocele forontal sinus and one patient of T.B granuloma of maxillary sinus. All 25 patients treated surgically via different approaches like lateral rhinotomy, Jansen Horgan ethmoidectomy and Weber Furgusson approach. Malignant cases also received radio, and chemotherapy, while patients of fungal sinusitis kept on antifungal treatment orally in post operative period. Proptosis caused by sinonasal pathologies once diagnosed must be treated promptly to get the best results. Radiations should be avoided if possible to prevent the loss of vision

Tympanometric analysis in otitis media with effusion in children. a study of the impact ear camps in Baluchistan

Otitis media with effusion [OME] in Pakistani children is a controversial subject. Tympanometry and acoustic reflex test performed in 189 children of Baluchistan in the age range of 2-10 years has revealed 13.49% of the ears having type B [5.29%] and type C [8.20%] patterns suggestive of otitis media with effusion and Eustachian tube dysfunction. Preliminary otoscopy performed in 297 children revealed tympanic membrane with signs of middle ear effusion in 22.48% of the ears. Acoustic reflex response was absent in 18 [9.52%] of the ears. Abnormal middle ear pressure [MEP] in 42 [11.1%] and physical volume [PV] in 13 [4.3%] of the ears was observed. Prevalence of OME in children Baluchistan with its possible contributory factors are discussed

causes of deafness and hearing impairment in cohorts at the Ida Rieu school, Karachi

This is a case control cohort study of comparable age, gender, socioeconomic and other multidirectional variables. The study was carried out in 334 children during the period between March and August 97, at the Ida Rieu Ear Institute in Karachi. The methodology comprised of collecting data based on a questionnaire filled by the parents. Clinical examination involved routine physical and thorough ENT examination. All subjects were evaluated through pure tone audiometry. The findings are comparable to the results of a previous study conducted in this school during the year 1991-93. In this study majority of children [76.64%] had profound hearing loss. Consanguinity, communicable diseases and ototoxicity seem to be the dominating factors

problem of noise

Noise is any unwanted sound that, by itself, may not be harmful unless its intensity is high. Noise has physical, physiologic, psychologic connotations, all of which differ. Physically, sound can be measured and defined in terms of duration, frequency [measured in Hz], and intensity measured in sound pressure levels SPL, expressed in decibels [dB]. Sound may be continuous, intermittent, impulsive, or explosive[1]

Pattern of leukocyte acid phosphatase reaction in T-cell lymphoblastic leukemia

Acid phosphatase [AP] reaction is a specific cytochemical marker for T-cell lymphoblastic leukaemia [T-ALL]. Twenty six cases of ALL were diagnosed as T-ALL employing cytochemical profiles including AP and sheep red blood cell rosettes. Three distinct patterns of AP reaction were observed. On one end of the spectrum, 100% of the positive blasts showed the classical dot- like reaction while on the other 100% showed a scattered reaction. Between the two a mixed pattern was observed with 30- 80% of the positive blasts showing the dot-like reaction while the rest showed scattered pattern. Dot-like pattern showed L[1] morphology, high counts and low SRBC rosettes while scattered showed L[2] morphology, low counts and high SRBC rosettes. The pattern observed in our series differs from the dot-like reaction observed in T-ALL in the western series. We recommend that this pattern must be borne in mind when employing AP reaction for T- ALL diagnosis

treatment of oral fibrosis with carbon dioxide [CO2] Laser

Oral Submucous fibrosis is a chronic insiduous disease of unknown etiology, commonly seen in Pakistan, particularly in Karachi, mainly afflicting the young who consume Areca nut [Supari]. Being a progressive condition, of ambiguous nature, no single modality has, so far been established for its treatment. Anything from as naive a thing as placebo pills to as aggressive a treatment as bilateral temporo-mandibular condylectomy have been advocated in the literature. This is a report of our experience in 55 cases of oral fibrosis, which were treated with Carbon Dioxide [C0[2]] Laser. There were 41 [74.5%] females and 14 [25.5%] males, varying between 15-50 years of age [mean 33 yrs]. They were treated between June 1989 - June 1990, with a followup period of 2-12 months. The equipment used was OPMILAS II, with an incorporated OPMI-I [ZEISS] operating microscope. The post surgical outcome shows an immediate improvement in opening of mouth. The follow up results indicate subjective improvement of symptoms of burning and discomfort on taking hot food. Taking into account the positive outcome of the surgery under the fact that most of the cases required single sitting, topical anaesthesia alongwith negligible postoperative pain and oedema highlights the effectivity of laser surgery in such cases. Its limited application in extreme cases and necessity for strict safety measures cannot however be ignored

Childhood cancer in Pakistan, special reference to retinoblastoma

International differences in rates and types of cancer serve as clues to its etiology. To study such variations of childhood cancer, we compared the frequencies of malignancy in the 220 children, age 0-14 years, diagnosed at the Jinnah Postgraduate Medical Center [JPMC], Karachi, Pakistan, 1974 - 1978, to the 1, 938 pediatric cancers in the U.S. Third National Cancer Survey [TNCS], 1969-1971. Type: Rectinoblastoma [RB]. JPMC: Not Equal 36, 16%. TNCS: 3%. Type: Non-Hodgkin's Lymphoma. JPMC: Not Equal 27, 12%. TNCS: 6%. Type: Leukemia. JPMC: Not Equal 26, 12%. TNCS: 33%. Type: Hodgkin's Disease. JPMC: Not Equal 20, 9%. TNCS: 4%. Type: Brian. JPMC: Not Equal 19, 9%. TNCS: 20%. Type: Wilms' tumor. JPMC: Not Equal 18, 8%. TNCS: 6%. Type: Soft tissue sarcoma. JPMC: Not Equal 18, 8%. TNCS: 4%. Type: Bone. JPMC: Not Equal 18, 8%. TNCS: 5%. Type: Gonadel, germ cell. JPMC: Not Equal 8, 4%. TNCS: 4%. Type: Neuroblastoma [NB]. JPMC: Not Equal 8, 4%. TNCS: 6%. Type: Other. JPMC: Not Equal 22, 10%. TNCS: 9%. The relative frequencies of cancers at the JPMC are similar to those reported from India, yet quite different from the TNCS, especially for 2 tumors of neuroectodermal origin RB and NB. Although RB was commonly diagnosed, it was bilateral in only 3 cases [8% vs 20% in U.S]. Bilateral RB, an autosomal dominant, is thought to occur among all peoples at the same rate; thus there appears to be an excess of sporadic RB. NB rates, low also in Central Africa, may be affected by a transplancental anticarcinogen. Lymphoma rates have an opposite pattern, they are increased and more often of a therapy-resistant subtype than in highly developed countries [RB-Retinoblastoma - NB - Neuroblastoma]