Sudden vision loss caused by rhino-orbital zygomycosis in diabetic patients: case series.

Rhino-orbital zygomycosis is a life-threatening fungal infection generally occurring in patients with an underlying disorder, such as diabetes mellitus with ketoacidosis or with immunocompromising factors, although it may rarely appear in healthy individuals. The study has been undertaken to discuss the clinical presentation, pathogenesis, diagnostic work up and management of this rapidly progressive disease. Four male patients having uncontrolled diabetes and presenting with signs and symptoms of rhino-orbital zygomycosis were studied to illustrate the serious nature of the disease. All the four patients had rapidly deteriorating vision loss either unilateral or bilateral along with other nasal and orbital signs and symptoms. All the patients were put on liposomal amphotericin B and underwent orbital exenteration and pansinusectomy. One patient died, while the other three were successfully treated. Early diagnosis is critical in the prevention of morbidity and mortality associated with the disease. There is need for a high index of clinical suspicion in immunocompromised patients. Timely medical-surgical treatment proves extremely important for prognosis.

Cervical tuberculous lymphadenopathy: changing clinical pattern and concepts in management.

Tuberculosis is one of the biggest health challenges the world is facing. In this study the clinical pattern of patients with cervical lymphadenitis, who presented to the ear, nose, and throat outpatient department of the Government Medical College Hospital, Chandigarh, India between June 1997 and May 1998 is recorded. Tuberculosis accounted for 60 out of 94 cases of cervical lymph node enlargement. The commonest age group affected was 11-20 years. Constitutional symptoms were not present in most of the patients. Multiple matted nodes were seen in 23 patients but a single discrete node was seen in 18 patients. Upper deep jugular nodes were the most commonly affected lymph nodes. Discharging sinus and abscess formation were uncommon. Fine needle aspiration cytology yielded a positive diagnosis in 52 out of 56 patients. Chest lesions on radiography were evident in 16% of the patients. Mantoux test was positive and was more than 15 mm in most of the patients. This study shows that the classical picture of "scrofula" is no longer seen nowadays and can probably be explained by the earlier presentation of the disease. All the patients were treated with short course daily chemotherapy for six months. Surgery was not required in the majority of patients except in four cases where excision biopsy was performed. Patients with abscess formation were managed with wide bore needle aspiration only. With a minimum six month period of follow up, no patient was found to have a recurrence of local or systemic disease. This study emphasises the role of fine needle aspiration cytology in diagnosis and confirms the efficacy of six months short course chemotherapy.

Clinicomicrobiologic evaluation of active tubotympanic type chronic suppurative otitis media.

OBJECTIVES: This prospective study was conducted to determine the spectrum of micro-organisms encountered in patients with active-stage chronic suppurative otitis media (CSOM) (tubotympanic type) and to see whether prescribing an antibiotic after culture sensitivity was more beneficial as compared to initial treatment without cultures. DESIGN: Prospective randomized study of 110 patients of active CSOM (tubotympanic type) divided into two groups of 55 cases each. SETTING: Departments of Ear, Nose and Throat and Microbiology of a tertiary care hospital. METHODS: The patients in group A were prescribed an antibiotic according to the culture and sensitivity, whereas in group B, culture was not done at the first visit, and a broad-spectrum antimicrobial, namely, co-trimoxazole, was prescribed blindly for a maximum period of 2 weeks. The cases that still had ear discharge were then subjected to culture and sensitivity and the antibiotic was prescribed accordingly. MAIN OUTCOME MEASURES: All patients in group A were subjected to bacterial culture and sensitivity and fungal culture. Only failed cases in group B were subjected to the same. RESULTS: In group A, 47 patients (85.50%) had positive bacterial culture and 20 patients had positive fungal culture. Pseudomonas aeruginosa was the most common bacterial isolate. All of these 47 patients had a dry ear with a maximum 2 weeks of antibiotic therapy. Among the remaining 8 patients who had negative bacterial culture, 5 patients (9.0%) showed fungal isolates on culture and responded to topical antifungal treatment. The remaining 3 failed cases (5.5%) responded to daily dry mopping alone. In group B, 41 patients (74.54%) attained a dry ear. Bacterial culture and sensitivity were done in the remaining 14 (25.46%) failed cases. The culture was positive in 11 patients (20.0%) and sterile in 3 patients (5.5%). In the latter group, only 1 patient had fungus on culture and the remaining 2 patients responded to daily dry mopping alone, which was done at a maximum for a week only. The most common fungal pathogen isolated was Aspergillus flavus. CONCLUSIONS: Pseudomonas aeruginosa was the most common bacteria and Aspergillus flavus the most common fungus isolated in this study. In group A patients, the failed cases were less as compared to the control group B, but the p value was .2. Hence, there is no definite role of culture and sensitivity in the initial management plan of all cases of CSOM. Ideally, every such case should be prescribed a broad-spectrum antibiotic and only in failed cases should culture and sensitivity be done.

Parathyroid cyst: a rare cause of an anterior neck mass.

Parathyroid cysts are rare. Most of them present in the anterior neck as cystic neck swellings. A case of cervical parathyroid cyst is presented, along with a brief review of the literature regarding the aetiology, clinical features, diagnosis and management of this condition.

Tuberculosis of the pyriform fossa--a rare entity.

Tuberculosis of the pharynx is less common than tuberculosis of the larynx. We present a rare case of tuberculosis of the pyriform fossa which clinically masqueraded as a malignancy. Our patient showed a prompt improvement in symptoms after commencing antitubercular treatment.

Surgical management of bilateral immobile vocal folds and long-term follow-up.

Sixty-one cases of bilateral immobile vocal folds were classified as traumatic (52.46 per cent), idiopathic (39.34 per cent) or iatrogenic (8.20 per cent). During follow-up the idiopathic group of patients had a better prognosis (p < 0.05) compared to the traumatic or iatrogenic group. A spontaneous recovery was seen in 58.33 per cent of cases in the idiopathic group, 56.25 per cent in the traumatic group and 40.0 per cent in the iatrogenic group within a period of one year. Patients who failed to show spontaneous recovery were either subjected to arytenoidectomy with fold lateralization, endoscopic fold lateralization or laser cordectomy, showing 70.0 per cent, 66.67 per cent and 80.0 per cent recovery respectively. These cases have been discussed.