Skull base injury leading to death after conventional septoplasty.

Treatment of nasal obstruction with conventional septoplasty is a very common operation in otorhinolaryngology. There are considerable complications that may become even life threatening. We report a rare complication of septoplasty, namely, skull base injury. The possible mechanisms and treatment modality are discussed. Like other similar procedures, prevention of the skull base injury is more important than its treatment. Correct knowledge about anatomy of the region and meticulous manipulation and instrumentation are the most considerable topics.

Hearing loss in chronic renal failure patient undergoing hemodialysis.

End stage renal failure patients, face to multiple complications. One of them is the involvement of auditory system. There are several proposed mechanisms for occurrence of hearing loss in these patients. There is no study performed in Iran for determining the status of hearing loss and results of audiometric tests in chronic renal failure patients. To assess prevalence, type and accompanying factors of auditory complications in end stage renal disease patients. Seventy chronic renal failure patients underwent clinical examination and audiometric tests. Their medical records reviewed to find out any contributing factor with auditory complications. There was higher prevalence of sensory neural hearing loss in CRF patients. The hearing loss was more obvious in higher frequencies. Its prevalence and severity increased with chronicity of renal failure and hemodialysis. There was not any difference regarding the sex. The hearing loss did not disturbed speech discrimination score and acoustic reflex. Sensory-neural hearing loss is common among CRF patients and deserves more attention than is paid by current approaches.

Comparison of two surgical methods (Winograd and sleeve method) in the treatment of ingrown toenail.

BACKGROUND: Ingrowing toenail is one of the most common nail complaints. Although many surgical treatments are described for complicated nails, frequent recurrence of pain and postoperative disability necessitate finding an appropriate treatment. METHODS: In a clinical trial, we compared the Winograd and sleeve (gutter) surgical methods to find a simple, painless, and practical alternative. RESULTS: Of 100 patients (mean 27.8) included in the study, 50 underwent Winograd surgery and the rest the sleeve method. Postoperative infection occurred in four (8%) patients in the sleeve and three (6%) in the Winograd group. The condition reoccurred in five (10%) patients who underwent sleeve surgery and six (12%) who underwent Winograd. Recurrence rate was higher in female patients, although the difference was not statistically significant. Mean surgery duration for Winograd and sleeve methods was 15.7 minutes and 9.4 minutes, respectively, and postoperative work day loss was 2.0 weeks and 1.1 weeks, respectively. CONCLUSION: The sleeve method seems to be more practical and appropriate for patients planning to go back to work sooner and better fulfills the main characteristics for the primary treatment of choice. The authors have indicated no significant interest with commercial supporters.

Neuro-otologic manifestations of multiple sclerosis.

BACKGROUND: Multiple sclerosis (MS) has numerous neurologic signs and symptoms, including hearing impairment. The reports concerning the type and severity of hearing loss in MS patients vary and little is known about an association of the disease characteristics with changes in hearing status. OBJECTIVE: To find the otologic and neuro-otologic manifestations of MS with the use of routine hearing assessment tools. METHODS: The presence of neuro-otologic signs and symptoms were studied in 30 patients diagnosed with MS. Patients underwent pure tone audiometry, speech audiometry and acoustic brain stem response (ABR) tests. The results were compared with 30 healthy age and sex matched controls. RESULTS: The most common finding was sensory-neural hearing loss followed by dizziness and nystagmus. The shape of the audiogram and severity of hearing loss was associated with both chronicity and disease activity. There were abnormal latencies in ABR waves which were more significant with high velocity stimulus. CONCLUSION: Hearing status deserves careful attention in MS patients. It may be used as a diagnostic means or an indicator for evaluating the characteristics of the underlying disease.

The role of endoscopic autopsy in trauma cases: the first report from Iran.

BACKGROUND: The traditional autopsy is unpleasant for the family members of the dead person. The aim of this study was to assess abdominal traumas by a laparoscope and to determine the accuracy of laparoscopic examination in comparison with the traditional autopsy. METHODS: From December 2004 through August 2005, 50 fresh cadavers (<24 hours old) of blunt trauma victims were selected. They were first assessed by a laparoscope for intraperitoneal and retroperitoneal organs and then the traditional autopsy was performed as gold standard. The organs were assessed regarding the nature and intensity of damages and the results were compared with laparoscopic findings. The diagnostic accuracy of laparoscope was determined for each case with 95% confidence intervals (CIs) using Fisher's exact test. RESULTS: The accuracy for investigation of intraperitoneal and retroperitoneal organs and the overall accuracy values were significant. The accuracy of laparoscope for detecting intraperitoneal organ damage was 90% (95%CI of 81.7%to 94.8%) while for the retroperitoneal organs was 92% (95%CI of 84.7% to 96%). The overall accuracy of laparoscope was 84% (with 95%CI of 74.3% to 90.5%). CONCLUSION: The sensitivity and specificity of laparoscopic examination for intraperitoneal organs are acceptable but its accuracy for retroperitoneal organs is lower. Therefore, it seems that laparoscopic examination is an eligible substitute for the traditional autopsy.