Adenoids in adult: Clinical and serological study, and endoscopic management

In this study, 49 adult patients with adenoid, proved endoscopically, were recorded. Clinical evaluation was done to detect any associated otorhinologic pathology. Serological tests for HIV, Epstein-Barr virus and cytomegalovirus was studied in the serum of these patients before surgery. Also, serial CT scan on the paranasal sinuses, tympanometry and acoustic nasometric analysis were done to all patients. A safe and more effective technique was proposed to be performed using endoscopic direct visualization during adenoidectomy in adults using 4.0 mm 0, 30 and 70 endoscopes. The adenoid curette was applied transorally to the nasopharynx to remove the main bulk of the adenoids. To remove the peritubal residual adenoid tissue or any residual adenoid tissue obstructing the choanae, a transnasal approach with a straight Blakesley forceps or diode laser was adopted. This study showed that in our locality, adenoid in adults is not uncommon problem, especially in females. Endoscopically, the adenoid was seen to be located on the posterior wall of the nasopharynx or as entopic adenoid tissue in the choanae. Associated nasal pathology [e.g. septal deviation, hypertrophy mucosa on the turbinated] was present in cases with nasopharyngeal and choanal adenoid, while the associated aural complication did not recorded with choanal adenoid. Serological findings revealed that most cases showed positive cytomegalovirus IgG [86.8%] indicating old infection. HIV and infectious mononucleosis spot test were negative in all cases. The combined method of a transoral and transnasal 0 or 30 and 70 endoscopic approach offered a clear operative field. The surgical procedures were all performed under direct visualization. None of the 49 patients had complications, such as postoperative nasopharyngeal hemorrhage or injury to the Eustachian tube of choanae. This method has the potential to become the procedure of choice for adenoidectomy

Virtal CT colonoscopy versus conventional colonscopy: a prospective study

Thirty-two patients [22 males and 10 females, mean age 47 years] with different colorectal complaints were investigated by CT colonography. The scanning parameters were collimation of 5 mm, table speed of 6.25 mm/s and pitch of 1.25. All images were evaluated in axial slices, reformatted images with endoluminal and extraluminal views. All patients were reexamined by the conventional colonoscope, CT colonography and colonoscopy. The study concluded that the high resolution and multiple image display of CT colonography allow the detection of many colorectal lesions. CT colonography is also a noninvasive imaging modality that is particularly valuable in poor risky patients and for colorectal examination proximal to an obstructing lesion

occult ENT hazards in ICU patients

The comatosed patient is a disabled subject. The defense reflexes [e.g. sneezing and coughing] are impaired. Most of the care is directed towards the vital signs, blood gases monitoring and care of chest. The aim of this study is to detect the possible hazards that affect the upper respiratory tracts of comatosed ICU patients to reach useful conclusions for the E.N.T. care needed for them to avoid these hazards. Our study was done upon 34 comatosed ICU patients. We found that sinusitis, mainly caused by Gram-ve bacteria and anaerobes, was a common complication [50%], mostly the maxillary sinus. Tympanogram type B, indicating M.E.E, was a common finding [24%]. Nasal intubation increased the incidence of sinusitis and MEE markedly, and was mostly on the ipsilateral side. Laryngotracheal complications were found in 12 [35%] cases, and the most frequent complication was tracheal stenosis then vocal cord granuloma and immobility. All cases with laryngotracheal complications were having endotracheal intubation [nasal or oral] especially when two intubations [gastric and endotracheal] were present in the same patient. The incidence of sinusitis, MEE,and laryngotracheal complications were significantly correlated with the duration of intubation, nasal and/or throat colonization on admission, pneumonia and association of general diseases. This study showed that daily E.N. T. examination is mandatory for ICU patients for the early detection of complications. The sinusitis and pneumonia were mostly caused by Gram-ve bacilli and anaerobes and this must be met with the proper antibiotics. CT scan on the nose and paranasal sinuses is mandatory on admission and serially thereafter for the early detection and treatment of hidden sinusitis. Oral intubation is preferred nasal intubation, avoid high-pressure cuff, avoid endotracheal reintubation if possible, the intubation must be as shorter as possible and avoid double intubation in the same patient [endotracheal and gastric]. Tracheostomy is preferred [in the first 7 days], tympanometry are mandatory to detect Eustachian tube obstruction, MEE or infection. Serial PH monitoring of the pharynx, for early detection of gastro-esophageal reflux, is essential and the ICU staff must be aware of the occult E.N.T. hazards of coma

Endoscopic diode laser assisted inferior dacryocystorhinostomy with mitomycin C

To assess the efficacy of using diode laser and intraoperative mitomycin C in increasing the success rate of endoscopic DCR and to minimize the bone work by constituting a surgical window in the area of ultra thin lacrimal bone. Twenty-three patients diagnosed as having nasolacrimal duct obstruction were included in this study. Endoscopic diode laser assisted DCR with minimal bone work and with the use of MMC was done for all cases .At the end of six months 18 out of 23 patients [78.2%] were relieved of their symptoms completely, 2 patients showed incomplete improvement, while 3 patients [13.1%] continued to have persistent epiphora. The success rate was 86.9%. Turbino-nasal synechia formation occurred in one case [4.4%], Turbino-septal synechia formation and granulation tissue occurred in one case [4.4%] and granulation tissue only in one case [4.4%] endoscopic diode laser assisted DCR with minimal bone work and with the use of MMC in this series compares favorably with other techniques described in the literatures. This technique has the advantages of shortening operative time, decreasing the incidence of complications and good rate of success

Doppler sonography of vertebral arteries in young patients with vertigo - without apparent otogenic causes

Forty-eight young patients with vertigo without apparent otogenic causes were investigated to determine values of blood flow velocities and hemodynamic changes in extra-cranial vertebral arteries [VAS]. Color flow Doppler ultrasonography was used for the detection of a possible cause of vertigo in these cases. Electronystagmography was done to correlate its findings with that of vertebral arteries Doppler blood flow [VABF] and to study accuracy and reliability of this recent tool of investigation. A significant slow VABF was reported in vertigo group compared with the control group. Velocity of vertebral artery in 54.2% of the cases showed abnormal findings; a laterality group in 29.2% and the group with lower circulatory velocity in 25%. In about 67% of cases, the results of Doppler and ENG were in good agreement with each other. The ENT results of most of the cases of the laterality group were recorded to be of a central disorder

Assessment of posterior pharyngeal wall augmentation in cases of velopharyngeal insufficiency by conchal cartilage graft

Posterior pharyngeal wall augmentation is an effective method for correcting mild to moderate cases of VPI. This was done on 12 patients with VPI by using a conchal cartilage with its perichondrium which was harvested from the ear. Localization of the site of implantation was determined using nasoendoscopy. This surgical technique carries many advantages as it allows more augmentation of the posterior pharyngeal wall due to the archiform shape of the conchal cartilage which is easily taken without donor side morbidity and easy to be harvested. A larger sample is needed with long-term follow up periods. Also, the phoniatric assessment of these cases showed that the proper selection of cases with mild or moderate degrees of open nasality is essential for using this technique

Doppler sonography of vertebral arteries in patients with tinnitus but normal hearing

Thirty-six patients with tinnitus but normal hearing [as proved by pure-tone audiometry and immittancemetry] were investigated to determine the values of the blood flow velocities and the hemodynamic changes in the extra-cranial vertebral arteries [VAS]- by color flow Doppler ultrasonography-for the detection of a possible cause of tinnitus in these cases. Further investigations were done to correlate their findings with that of vertebral arteries Doppler blood flow [VABF] and to study the accuracy and reliability of this recent tool of investigation. Abnormal Doppler findings could be detected in 15 cases. A significantly slow VABF was reported in tinnitus group compared with the control group

Nifedipine versus fentanyl to prevent the pressor response to tracheal intubation

Thirty six patients ASA 1 or 2, undergoing surgery that required tracheal intubation, were allocated randomly into three groups of twelve each. Before induction of anesthesia, they received either saline, 10 mg, nifedipine sublingual, or fentanyl 1.5 micro g. kg [-1] IV. Heart rate [HR], systolic blood pressure [SAP], diastolic blood pressure [DBP], and mean blood pressure [MAP], were recorded automatically every minute for 5 minutes before induction of anesthesia, and for 5 minutes after intubation. Nifedipine was better than fentanyl in blocking the pressor response. The fentanyl dose was too small to abolish this response completely. The increase in HR and blood pressure were most evident in the control group, followed by fentanyl, and the least increase was seen with nifedipine

Growth of prawn pennies latisulcatus kishinouye in the gulf of Suez-Egypt

Penaeus latisulcatus Kishinouye is considered one of the most important Penaeid species inhabiting the areas of Gulf of Suez and Red Sea. No pervious information is available concerning its age and growth in Egyptian waters. In the present study, age and growth of P. latisulcatus were estimated by applying the integrated method. The species attains 17.20 cm total length [6.4 cm carapace length] after 24 months for males and 20.0 cm total length [7.7 cm carapace length] after 27 months for females with an average monthly growth increment of 0.72 cm and 0.74 cm total length [2.65 mm and 3.19 mm carapace length] for males and females respectively. At the end of the first and second years of life, males reach about 13.7, 17.2 cm in total length and the lengths of females are about 15.1, 19.6 cm respectively. The estimates of the theoretical growth in length as L alpha = 18.21 cm total length [6.8 cm carapace length], K = 0.353 [in 0.25 year-1 units] for males and L alpha = 21.77 cm total length [8.4 cm carapace length], K = 0.3073 [in 0.25 year-1 units] for females. The correlation between length and weight of P. latisulcatus in Suez Gulf water was found W = 0.003447, L = 3.299751 for the combined sexes. Females of P. latisulcatus reach 27.21 gm in weight, while males reach 19.12 gm 19.12 gm at the first year of life

Biological studies on penaeus semisulcatus De Haan in Gulf of Suez, Egypt

Penaeus semisulcatus De Haan represents about 23% of the prawn catch of Penaeid species of Gulf of Suez waters. It attains 21.8 cm and 24.7 cm total length [82.8 mm and 99.3 mm carapace length] after 30 months with a monthly growth rate 0.73 cm and 0.82 cm total length for both males and females respectively. The estimates of the theoretical growth parameters of the males as L alpha = 22.91 cm TL [8.69 cm CL], K = 0.2709 and the females L alpha = 26.11 cm TL [10.56 cm CL], K = 0.3075. There is a sexual dimorphism in size of P. semisulcatus collected from the Suez Gulf waters, which means a shorter life span of males than females or a higher growth rate of females. All females of P. semisulcatus above 10.4 cm TL [3.5 cm CL] were sexually mature. The species show a prolonged breeding season in Suez Gulf water from October to March. The monthly variation in G.S.I. in both sexes of P. semisulcatus indicates that males reach sexual ripeness before females with a possibility of frequent spawning throughout the year with the presence of a season of intensive breeding from October to March

Focus on the floor of the pulp chanber of the mandibular first molar, radiographic and scanning electron microscopic investigation

The presence of accessory canals from the floor of the pulp chamber to the furcation region was demonstrated. Thirty human mandibular first molars were sectioned apically and coronally. The floor of the pulp chamber of each tooth was examined by SEM. 40% of the teeth showed accessory canals on the pulp chamber floor. Maximum number of accessory foramina found in one tooth was four. The average distance between the pulp chamber floors and the outer furcation areas was 2.44 mm +/- 0.44. No relation was found between furcation thickness and the presence and/or number of the accessory canals. Each line drawn between the mesial and distal CEJ on each radiographic view of each lower first molar was touching the mesial and distal pulp horns making the whole pulp chamber beyond it

Isoflurane injection in totally closed circuit for middle ear surgery: safety, economy and controlled hypotension

Twenty-six patients undergoing middle ear surgery were anaesthetized with isoflurane [Forane] in oxygen using a completely closed circuit into which isoflurane was injected using syringe pump. Calculated rates of isoflurane delivery were used for different weight groups and were changed at succeeding time intervals aiming for constant alveolar concentration of 1.3 MAC. Injection rate was changed readily whenever clinical signs indicated inappropriate depth of anaesthesia. A mean of 10.3 ml liquid isoflurane was used to maintain anaesthesia for a mean of 82.3 minutes. Blood pressure was maintained at 75% the preoperative value. Mean arterial blood gas data and changes in plasma catecholamines level were within normal range. The mean recovery period was 10.5 minutes. The technique is safe, economic and able to adapt to variations in uptake and response to isoflurane. It also leads to excellent surgical conditions by minimizing bleeding in the surgical field

monthly changes in the hepatopancreas index and its effect on moulting in lobster thenus orientalis [land, 1793]

Hepatopancrease and its storage of food matters has a direct action on moulting. The weight of hepatopancrease increases in the period between two moulting processes, while it suddenly decreases after moulting directly. By tracing the periods at which the hepatopancrease reaches its maximum or minimal value, the number of moulting process in the year can be detected. There are 3 moulting cycles for males and 2 for females per year in T. orientalis within the studied length range

Reproduction in thenus orientalis from the Arabian gulf waters of Saudi Arabia: A-maturity stages and seasonal reproduction

The shape of female and male gonads in T. orientalis were described. Four maturity stages in female ovary were determined. The last stage was that at which the females carry eggs on their setae of pleopods. Black lobsters were not frequent [about 0.5% of the examined females]. Three stages of gonad maturation were determined for the males according to the color and shape of the testis. Not all ripe eggs were extruded by the female at the same time. Egg carriers were abundant in the months of January, February and July. On the other hand, we can find egg carriers in small number throughout the year. Ripe males were noticed in the months of December; T. orientalis was found to vary between 7424 and 38637 eggs/female, and a straight line relationship was found between length of a female and its fecundity

Haemodynamic changes during anaesthesia before and after mitral commissurotomy

Thirty patients with pure mitral stenosis scheduled for closed mitral commissurotomy were included in the present study. Cardiac output [CO], mean pulmonary artery pressure [PAP] and pulmonary capillary wedge pressure [PCWP] were measured and total pulmonary resistance [TPR], pulmonary vascular resistance [PVR] and mitral valve resistance [MVR] were calculated. Anesthesia decreased the cardiac output significantly. This cardiac output increased dramatically immediately after surgery from 2.49 +/- 9.77 to 4.61 +/- 0.95 l/min. PAP and PCWP decreased significantly after commissurotomy and there was a correlation between PCWP and PAP before and after surgery. IPR, PVR and MVR decreased significantly after mitral commissurotomy. A good correlation was obtained between PVR and the pulmonary gradient [PAP-PCWP] before and after operation