Fourth branchial pouch sinus: A report of 7 cases and review of the literature.

A fourth branchial pouch sinus often manifests quite late in life as a recurrent neck abscess, suppurative thyroiditis, or pseudothyroiditis. Demonstration of the sinus opening in the piriform fossa by hypopharyngoscopy in combination with ultrasonography of the neck provides adequate information to justify proceeding to surgery. The sinus tract usually courses through the thyroid cartilage. The most effective treatment is surgical excision of the tract up to the piriform fossa through the cartilage. This procedure is associated with very low complication and recurrence rates. A fourth branchial pouch sinus is an uncommon condition. Even so, it is still underdiagnosed as a result of poor awareness of its existence by medical practitioners, including otolaryngologists. Part of the reason is a lack of adequate coverage of this topic in otolaryngology and surgery textbooks. In this article, we add to the literature by describing our experience with 7 patients-4 males and 3 females, aged 5 to 45 years (mean: 25.6)-who were diagnosed with a fourth branchial pouch sinus over a 6-year period. The diagnosis was confirmed by identifying the sinus opening at the apex of the piriform sinus during hypopharyngoscopy. Definitive treatment consisted of surgical exploration of the neck and excision of the tract.

Is surgical intervention for ectopic pregnancy in a low resource set-up avoidable?

BACKGROUND: Ectopic pregnancy is one of the most common life threatening complications in the first trimester of pregnancy having significant adverse effects on future pregnancy outcome, particularly if salpingectomy is used as the modality of treatment. So medical management is now advocated. For that, cases need to be diagnosed at an earlier stage. Keeping these backgrounds in mind we took up this study to look into the feasibility of conservative management- both medical and surgical - in a tertiary care centre. AIMS: To find out the demographic profile and risk factors of the ectopic pregnancy cases; the clinical presentation of the cases; the mode of treatment offered to the patients. MATERIALS AND METHODS: It was a record based retrospective study.All the patients diagnosed as ectopic pregnancy in a tertiary care hospital from January, 2011 to December, 2012, was included in the study. RESULTS: A total of 234 ectopic cases (1.5% of total deliveries) were recorded, constituting 5.4% of total gynaecological emergencies of this institute. Majority of patients were multigravida (74.4%) and of age group of 26-30years (35.9%). Fallopian tube was the most common site (99.1%) with only two cases in ovary. Ampulla (71.4%) was found to be most frequent site for implantation in fallopian tube. Pelvic inflammatory diseases (38.5%) and past history of induced abortion (35.9%) were major risk factors. Most patients (63.3%) did not use any contraceptives and 30.3% patients used OCP intermittently. No patient presented before 4weeks of gestation, while 69.2% presented between 4-7weeks and the rest beyond 7week. They presented with shock in 44.9% cases. Surgical treatment was offered in 98.3% cases, while medical treatment was offered to only four cases. CONCLUSION: There is a huge surgical burden due to ectopic pregnancy impinging on our hospital resources. Surgery is resorted to indiscriminately for even those cases that could have been medically treated otherwise. Hence, the need to change the mindset of the care-providers at all levels to opt for medical management of ectopic pregnancy wherever applicable.

Albuminuria and neuropathy in newly detected diabetics: profile and correlation.

Neuropathy and nephropathy are two most common chronic complications of diabetes mellitus. Albuminuria and neuropathy has been found to be associated in patients with long standing diabetes. In the present study, the profiles of proteinuria and neuropathy have been studied in newly diagnosed cases of type 2 diabetes mellitus and attempt has been made to determine any relationship between the two. We studied 100 newly diagnosed ceases of type 2 diabetes mellitus and presence and type of neuropathy was assessed clinically and electrophysiologically. Albuminuria was detected by morning spot sample for albumin to creatinine ratio estimation. Results were analysed using appropriate statistical methods. It was found that 21 patients (21%) had proteinuria and 31 (31%) had neuropathy. Both were present in 16% patients and absent in 64% cases. The overall prevalence of neuropathy and proteinuria among study subjects was 36%. Isolated peripheral neuropathy was found in 9% patients, isolated autonomic neuropathy was found in 7% patients, and both were present in 15% cases. Proteinuria was mostly micro-albuminuria (90.5%). Occurrence of albuminuria and neuropathy has been found to be significantly associated with increasing age. Concurrence of diabetic neuropathy and albuminuria has been found to be significantly associated. The present study reveals that presence of neuropathy as well as nephropathy is common in newly diagnosed cases of type 2 diabetes mellitus. Both these complications have been significantly associated with increasing age indicating the possibility of a longer duration of undetected diabetes among them. Concurrence of neuropathy and nephropathy found in this study suggests that microvascular complications go hand in hand.