ABSTRACT
The clinical features and management of 22 cases with proptosis is highlighted. Proptosis was unilateral in fifteen and bilateral in seven cases. The common etiologic factors were neoplasms, infections and bleeding diatheses. Of the ten cases with neoplasms as many as 7 expired, whereas of nine cases due to infections only one expired and one developed phthisis bulbi. All three patients with proptosis due to bleeds recovered completely without sequelae. Orbital CT scan was done in fourteen and ultrasound in eight cases, while in five cases both investigations were done. As neoplasms are a frequent cause of proptosis in children and there is a high mortality in this group, a thorough systemic examination and hematological profile is essential to arrive at a speedy diagnosis. CT and USG are useful imaging modalities of the orbit, the latter being particularly useful for follow up of the lesion.
Subject(s)
Exophthalmos , Child , Child, Preschool , Exophthalmos/diagnosis , Exophthalmos/etiology , Exophthalmos/therapy , Female , Humans , Infant , Infant, Newborn , Male , Orbit/diagnostic imaging , Tomography, X-Ray Computed , UltrasonographyABSTRACT
Twenty two patients presented with otogenic tetanus. Seventeen patients had acute histories with only a single episode of otitis media with otorrhoea. Fifteen patients had unilateral central perforations, five had bilateral central perforations and two had no perforations but had acutely congested tympanic membranes which were bulging suggesting the presence of purulent fluid behind them. All patients with perforations had a purulent pulsatile discharge. A coexisting aerobic infection was seen in 85 per cent of the cultures and 59 per cent of these were due to staphylococcus aureus (versus 25 per cent in the controls). Only one patient had received partial immunization. Tetanus resulting from otitis media is not an indication for surgery.
Subject(s)
Otitis Media/complications , Staphylococcal Infections/complications , Tetanus/complications , Acute Disease , Case-Control Studies , Child , Child, Preschool , Ear/microbiology , Female , Humans , Infant , Male , Middle Aged , Otitis Media/microbiology , Prospective Studies , Tetanus/microbiologyABSTRACT
Thirty cases of cerebellopontine angle epidermoid cysts treated over a period of 20 years are reviewed with regard to their clinical features, the pathophysiology of their symptoms and their management. The predominating symptoms were related to the 7th and 8th cranial nerves and headaches. The signs and symptoms were present for an average period of 4 months. It was not always possible to determine if the signs and symptoms were due to local involvement by the epidermoid, increased intracranial pressure, or both. Diagnostic procedures evolved from angiography and ventriculography to non-invasive computed tomography and MRI. The posterior cranial fossa approach was used in 27 cases. Total excision of the epidermoid was the aim and was carried out in five (18%) patients but concern regarding the preservation of nearby important neurovascular structures forced partial removal in 22 patients. To minimise reformation, the residual epidermoid was carefully coagulated with the aid of the operating microscope and bipolar cautery without damaging surrounding neurovascular structures.
Subject(s)
Cerebellar Diseases/surgery , Epidermal Cyst/surgery , Adolescent , Adult , Cerebellar Diseases/diagnosis , Cerebellopontine Angle/surgery , Child , Electrocoagulation/methods , Epidermal Cyst/diagnosis , Female , Humans , Male , Microsurgery/methods , Middle Aged , Retrospective Studies , Tomography, X-Ray ComputedABSTRACT
Congenital cholesteatomas of the petrous apex are now frequently being approached by otologists. Involvement of the cerebello pontine angle by this lesion produces a myriad of signs and symptoms. Otological as well as neurosurgical literature is reviewed to achieve an overall understanding of the nature and behaviour of this uncommon but interesting lesion.
