Oncogenic osteomalacia secondary to glomus tumor.

SUMMARY: Oncogenic osteomalacia secondary to glomus tumor is extremely rare. Localization of causative tumors is critical as surgical resection can lead to a complete biochemical and clinical cure. We present a case of oncogenic osteomalacia treated with resection of glomus tumor. A 39-year-old woman with a history of chronic sinusitis presented with chronic body ache and muscle weakness. Biochemical evaluation revealed elevated alkaline phosphatase hypophosphatemia, increased urinary phosphate excretion, low calcitriol, and FGF23 was unsuppressed suggestive of oncogenic osteomalacia. Diagnostic studies showed increase uptake in multiple bones. Localization with MRI of paranasal sinuses revealed a sinonasal mass with concurrent uptake in the same area on the octreotide scan. Surgical resection of the sinonasal mass was consistent with the glomus tumor. The patient improved both clinically and biochemically postoperatively. Along with the case of oncogenic osteomalacia secondary to a glomus tumor, we have also discussed in detail the recent development in the diagnosis and management of oncogenic osteomalacia. LEARNING POINTS: Tumor-induced osteomalacia is a rare cause of osteomalacia caused by the secretion of FGF23 from mesenchymal tumors. Mesenchymal tumors causing TIO are often difficult to localize and treat. Resection of the tumor can result in complete resolution of biochemical and clinical manifestations in a very short span of time. Glomus tumor can lead to tumor induced osteomalacia and should be surgically treated.

Complications in a series of 4400 paediatric cochlear implantation.

OBJECTIVES: The purpose of this study is to retrospectively review the complications of paediatric patients undergoing cochlear implantation at four major Iranian cochlear implant centres. METHODS: A retrospective analysis was performed of all patients who underwent primary cochlear implantation from January 1991 to December 2013. The patients were reviewed for demographic information, and complications including cerebrospinal fluid leak, meningitis, facial palsy, and wound infection. RESULTS: 4400 records were reviewed. Fifty-four patients were lost to follow-up; therefore, 4346 records were analysed. The most common aetiology of hearing loss was non-syndromic genetic sensori-neural hearing loss (69%). Other less common aetiologies of hearing loss included TORCH (Toxoplasmosis, Other infections, Rubella, Cytomegalovirus, Herpes) (11%), syndromic hearing loss (7%), ototoxicity (5%), and autoimmune inner-ear disease (4%). The most common major complications were CSF leak (0.4%), skin necrosis (0.2%), meningitis (0.1%), facial paralysis (0.07%) and massive haemorrhage (0.05). CONCLUSION: Cochlear implantation continues to be reliable and safe in experienced hands, with a very low percentage of severe complications.

Salivary gland tumors in maxillofacial region: a retrospective study of 130 cases in a southern Iranian population.

Tumors of the salivary glands are uncommon head and neck neoplasia. We conducted a retrospective study of 392 cases over the last 6 years in Shiraz, south of Iran, to investigate the clinicopathological features of these tumors in Iranian population. The age of the patients ranged from 8 to 85 years, with the mean age 44.57 ± 14.65 years and male-to-female (M : F) ratio was 1.02 : 1. For benign tumors, there was a propensity towards females, whereas the malignant tumor was more common in males. The ratio of benign tumors to malignancies was 2.19 : 1. Pleomorphic adenoma (PA) was the most common tumor and accounted for 85% of all benign tumors, followed by Warthin's tumor (8.6%). Of the 125 malignancies, adenoid cystic carcinoma (40%), mucoepidermoid carcinoma (24%) and invasive squamous cell carcinoma (16%) were the most common histological types. Most of the salivary gland tumors (75%) originated from major salivary glands and the remained (25%) originated from minor glands. The parotid gland was the most common site both in benign and malignant tumors. Most of our findings were similar to those in the literature, with some variations. The salivary tumors slightly predominated in males. Adenoid cystic carcinoma and mucoepidermoid carcinoma constituted the most common malignancies.

Comparison between topical honey and mafenide acetate in treatment of auricular burn.

The auricle is a frequently injured part of the head and neck during thermal injury leading to ear deformity. The burned ear represents one of the most difficult problems for reconstructive surgeons. Mafenide acetate is a topical agent used routinely for these patients, but it has some disadvantages including painful application and allergic rash. Some authors have reported the healing effect and antibacterial activity of honey. The study reported here was undertaken to compare the effect of honey and mafenide acetate on auricular burn in rabbit. In our study, although the pathologic score of the honey group was better than that of the mafenide group both on 14 and 21 days after burning, it was not statistically significant. In the mafenide acetate group, deep complication of burn (chondritis) was significantly lower than that of the honey group. In conclusion, in contrast to healing and antibiotic activity reported for honey, it may have failure in preventing deep bacterial complications of wound (like chondritis). So in deep wounds, the use of honey as dressing is not recommended.

Long-term follow-up of patients with microscopic endonasal dacryocystorhinostomy.

BACKGROUND: Stenosis of the nasolacrimal drainage system is a relatively frequent complication of acute or chronic inflammation, trauma, tumor, or congenital malformation. Symptoms include epiphora, intermittent purulent secretion, and swelling of the nasolacrimal sac. The principle of dacryocystorhinostomy (DCR) is to create an artificial opening of the lacrimal sac into the nasal cavity. This can be done via an external as well as an endonasal route. METHODS: In this retrospective study, we examined 74 microscopic endonasal DCRs. which were performed on 70 patients between 1990 and 2000. All of the 74 DCR operations had no major complications intraoperatively. RESULTS: Sixty DCR procedures (81.1%) were successful after a mean follow-up time of 3.18 years. This success rate is lower than those rates reported in the literature for the external approach, which range between 85 and 99%, although follow-up times were shorter in most of these studies. CONCLUSIONS: Advantages of the endonasal approach such as saving the medial palpebral ligament, the lacrimal pump mechanism, and the horizontal apparatus are obvious. If necessary, additional management of sinus, septal, and conchal disease can be performed simultaneously. Our results reveal that the microscopic endonasal approach is a safe and reliable procedure in the management of postsaccular or saccular nasolacrimal duct obstruction and is an alternative to the traditional external route.