Unilateral absent vestibular evoked myogenic potential in a patient presented with balance disorder: a case report

A case of 22-years old female patient, who suffered from a sudden onset of imbalance, complained of floating sensation and had a history of falls. Her main difficulty was when using the elevator, where she felt severe imbalance. All other clinical balance assessments were normal, but positive findings were found in Fukuda test, Romberg's test and straight-line test. While the blood investigation, caloric test and MRI of the brain were unremarkable, smooth pursuit, saccade and posturography test were abnormal. Vestibular Evoked Myogenic Potential [VEMP] test was found to be completely absent in the right side but a robust VEMP was found in the left side. Malay version of vertigo symptom scale [MVVSS] analysis showed that her imbalance level was in a severe range. The diagnosis of this patient was very challenging but based on her history of difficulty using the lift and VEMP findings, a right saccular dysfunction was suspected. The patient then underwent Customized Cawthorne-Cooksey exercise [CCCE], together with betahistine tablets. VEMP and MVVSS were reassessed after the patient had a 2-week of intensive CCCE. Surprisingly, VEMP waveform was now clearly visible in the right side. However, the asymmetrical issue was still observed, suggesting that the right side was still [abnormal], as compared to the left side. MVVSS score showed a significant improvement, consistent with VEMP findings. This nevertheless demonstrates that in a case of flat VEMP, combination of an intensive physical vestibular rehabilitation and typical medications can result in rapid recovery of vestibular symptoms

Laryngoceles associated with laryngeal carcinoma

Laryngoceles and large saccules were found in 3.07% and 5.12% of patients with laryngeal carcinomas. CT proved to be very accurate more than endoscopy in detection of asymptomatic laryngocele associated with cancer larynx. However both endoscopy and CT are recommended in cases presented primarily with laryngoceles to rule out any underlying malignancy. Laryngoceles were bilateral in 50% of cases. Large saccules were ipsilateral in 60% [6/10], bilateral in 10% [1/10], and contralateral in 30% [3/10] of cases. Four patients with supraglottic tumors [4.54%] were associated with two bilateral symptomatic and two asymptomatic ipsilateral laryngoceles. Two patients with transglottic tumors [3.44%] showed asymptomatic ipsilateral internal and bilateral mixed laryngoceles. All asymptomatic laryngoceles were diagnosed by CT and postoperative examination of the specimens as patients presented usually with symptoms related to the tumor. Large saccules were found in 5.68% of supraglottic tumors, 4.76% of glottic tumors, and 5.17% of transglottic tumors. 60% [6/10] of large saccules were ipsilateral, 30% [3/10] were contralateral, and 10% [1/10] was bilateral

Imagenología en el estudio diagnóstico de la infertilidad masculina / Imaging in the diagnostic study of male infertility

El progreso de la imagenología de alta resolución como la ecotomografía endocavitaria prostática (ETR) y la aparición de la resonancia nuclear magnética (RNM) han relegado a un segundo plano a la vesículodeferentografía (VDG). Dado que la RNM está lejos del alcance de la mayoría de los andrólogos, se analiza la experiencia con el uso de la ETR y VDG en la evaluación de 17 pacientes que consultan por infertilidad de factor masculino. Ambas técnicas imagenológicas resultan útiles, complementarias y no excluyentes. Deben estar disponibles y en conocimiento de todo andrólogo