Utility of apparent diffusion coefficient in characterization of different sinonasal pathologies.

BACKGROUND: Sinonasal lesions are a heterogeneous group of lesions that span from a tumor to tumor-like nature. Characterization of such cases preoperatively can improve the surgical control and the overall outcome of these patients. OBJECTIVE: In this prospective study, we aimed at evaluation of the role of apparent diffusion coefficient (ADC) in the differentiation between benign and malignant sinonasal lesions. SUBJECTS AND METHODS: All patients scheduled to have sinonasal surgical intervention at Ain Shams University Hospitals, Cairo, Egypt, were enrolled. Diffusion-weighted (DW) magnetic resonance imaging (MRI) with calculation of ADC were done for all cases. Radiologic findings were then compared with histologic findings, and the sensitivity, specificity, negative and positive predictive values (PPVs) of the conventional MRI, DW-MRI, and ADC value in differentiation of benign from malignant sinonasal lesions were then calculated. RESULTS: There were 59 patients with median age of 43 years old. There were 20 cases of inflammatory lesions, 16 cases of benign tumors, and 23 cases of malignant lesions. The ADC values of all cases ranged from 0.4 × 10(-3) to 2 × 10(-3) (median = 1.5 × 10(-3)). The median ADC value for the malignant lesions was 0.6 × 10(-3), whereas that for the inflammatory conditions was 1.6 × 10(-3) and that for the benign tumors was 1.5 × 10(-3) with a highly significant difference (p < .001). Analysis of the conventional MRI and DW-MRI to differentiate between malignant and benign lesions showed that the sensitivity, specificity, PPV, and negative predictive value (NPV) were 100%, 97%, 96%, and 100% and 91%, 97%, 95%, and 95%, respectively. CONCLUSION: DW-MRI did not add significantly to the information gained from conventional MRI. It should be considered complimentary only to standard MRI in uncertain cases when malignancy is still a concern.

Detubularised isolated ureterosigmoidostomy (Atta pouch): Manometric and radiological studies in a sample of patients.

OBJECTIVES: To assess whether the detubularised isolated ureterosigmoidostomy (DIUS) technique is safe for urinary diversion after radical cystectomy. PATIENTS AND METHODS: The study included 10 patients (mean age 61.8 years) with invasive bladder tumour, operated at the Alexandria University, Egypt. The diversion in all patients was through a DIUS, with ureteric reimplantation by an antirefluxing procedure, using an embedded-nipple technique. The patients were evaluated before and after surgery using radiological and manometric studies, and the results analysed statistically using Student's t-test. RESULTS: Nine of the 10 patients could differentiate between urinary and stool sensation, and evacuate them separately. The mean (range) daytime frequency was 4.1 (3-5) and the mean night-time frequency was 0.5 (0-1). Before and after surgery, the respective mean resting anal pressure was 71 and 74 cm H2O (P = 0.004), the volume at first desire to defecate was 54 and 72 mL (P = 0.004) and the maximum tolerable volume was 140 and 160 mL (P < 0.001). The anorectal inhibitory reflex was lost in all patients after surgery. The mean (SD, range) basal pouch pressure was 5 (3.33, 0-10) cmH2O, and the end pressure was 13.2 (4.42, 9-20) cmH2O. CONCLUSION: Although the Mainz II pouch has a documented efficacy for urinary diversion after radical cystectomy, the modifications we applied to the DIUS improved that method of diversion, by separating urine and stool evacuation, maintaining continence, and with a low frequency and better protection of the upper urinary tracts, resulting in an improvement in the patients' quality of life.

Benefit of combined endoscopic sinus surgery and aesthetic rhinoplasty.

INTRODUCTION: Rhinoplasty is one of the most commonly performed aesthetic procedures today. Although nasal airway obstruction is frequently treated concomitantly with the aesthetic procedure, chronic sinusitis has typically postponed until full resolution of inflammatory symptoms. AIM OF THE STUDY: To investigate the feasibility of combining FESS with septorhinoplasty by measuring different outcomes including operative time, blood loss, post-operative edema of the upper and lower eyelids, periorbital ecchymosis, patient discomfort and complication rates. PATIENTS AND METHODS: The study included 20 patients with deformed nose associated with chronic rhinosinusitis (CRS) not responding to medical treatment for at least 3 continuous months, irrespective to sex, of ages 20-60, and without any systemic diseases (study group), and 20 patients with deformed nose without any sinus problems (control group). RESULTS: There was no significant difference between the two groups in the different measured outcomes (P>0.05) except for the operative time which was significantly less in the control group (P<0.05). CONCLUSION: Concurrent rhinoplasty and endoscopic sinus surgery may be performed safely and effectively with minimal risks. Proper patient selection and sound intraoperative judgment can avoid potential complications.