Nasolacrimal Duct Management During Endoscopic Sinus and Skull Base Surgery.

OBJECTIVE: To evaluate rates of epiphora after transection and marsupialization of the nasolacrimal duct (NLD) during endoscopic sinus and skull base surgery. INTRODUCTION: The nasolacrimal canal forms part of the medial wall of the maxillary sinus. Transecting the NLD is sometimes necessary for tumor resection or surgical access to maxillary sinus and infratemporal fossa pathology. There is no consensus for the endoscopic management of the NLD when only the duct is transected without involving the nasolacrimal sac. METHODS: Medical records of 29 patients from 2 academic institutions who underwent endoscopic sinus and skull base surgery with transection of the NLD were retrospectively reviewed. Whether the duct was marsupialized or simply transected was recorded, and the postoperative rate of epiphora was calculated. RESULTS: Mean age was 59 years (range, 14-86 years). Mean follow-up was 10.5 months (range, 1-33 months). The NLD was marsupialized in 16 (55%) and simply transected in 13 (45%) patients. Six patients underwent postoperative radiation. No patients in the marsupialization group had epiphora postoperatively, all with Munk score of 0. One patient in the transection group developed postoperative epiphora with Munk score of 1. Pathology included inverted papilloma (8), acute on chronic inflammation (6), B-cell lymphoma (3), juvenile nasopharyngeal angiofibroma (2), squamous cell carcinoma (2), Schneiderian papilloma (2), metastatic melanoma (1), HPV-related carcinoma (1), adenocarcinoma (1), benign epithelial cyst (1), adenoid cystic carcinoma (1), and erosive chronic sinusitis without nasal polyposis (1). CONCLUSION: Management after transection of the NLD varies widely. The duct may be simply transected or marsupialized, or a formal dacryocystorhinostomy can be performed. The surgeon must also choose whether to place a stent. Based on our small series and review of the literature, marsupialization or simple transection of the NLD results in a low rate of postoperative epiphora in the setting of endoscopic sinus and skull base surgery.

Measuring Quality of Life in Type 2 Diabetic Patients at the Al-Wazarat Healthcare Center in Riyadh.

Background The prevalence of type 2 diabetes in the Saudi population is increasing at an alarming level. Diabetes is characterized by a considerable health and economic burden on the population and affected individuals. Objectives This study aims to assess the level of quality of life in type 2 diabetic patients and to investigate the determinant of quality of life in a primary health care setting. Methods The study used a cross-sectional design to investigate the quality of life among type 2 diabetic patients at the Al-Wazarat Health Care Center (WHC) in Riyadh, Saudi Arabia. The study used the Arabic version of the quality of life 36-items short-form questionnaire (SF-36). Results The study included 482 completed questionnaires out of the 525 distributed. The response rate is 91.8%. The average age of the patients is 56.3 ± 7.8 years. The self-reported average body mass index (BMI) is 31.6 ± 6.6 kg/m2. The duration of diabetes since diagnosis is 9.7± 3.1 years. The most common comorbidity was hypertension 75.9% (366/482). The multivariate regression analysis provided models that explained the role of certain variables in determining the quality of life in type 2 diabetic patients significantly. The most striking results are explaining the factors affecting physical functioning by 41% (R2=0.41) and mental health by 34% (R2=0.34). Conclusion This study can influence the practices of medical practice and promotion in WHC specifically and Riyadh city more generally. The improvement and preservation of HRQoL in diabetic patients required an understanding of the factors that can influence it. The gender disparity is an area that needs further investigation. Changes in the delivery of healthcare in diabetes clinics to account for these factors may provide better results.