A Rare Occurrence of an Extensive Sino-Nasal Solitary Fibrous Tumour.

Introduction: Solitary fibrous tumours are uncommon in head and neck region, especially in the nasal cavities and paranasal sinuses, with most cases reported in the thoracic region in the pleura. It is often considered a borderline or low-grade malignant soft tissue tumour. Complete surgical resection is currently the treatment of choice, though intracranial and orbital extension of these lesions must be carefully evaluated and navigated to ensure a safe outcome. Case Report: A 36 years-old lady presented with a long one-year history of left-sided nasal obstruction with facial pain, headaches and mild visual disturbances. She had been treated for sinusitis for a prolonged period. Clinically, there was a left nasal mass obliterating the ostiomeatal complexes and the roof of the nasal cavity. MRI showed heterogeneously enhancing mass occupying the left ethmoid sinuses extending laterally eroding the left lamina papyracea to the orbit, medially towards the right nasal cavity eroding the nasal septum, and superiorly to extend intracranially. After inconclusive biopsies were performed, the mass was excised with a combined endoscopic and open lateral rhinotomy approach with left medial maxillectomy and reconstruction of the skull base defect. The tumour was eventually reported as a solitary fibrous tumour. Conclusions: Solitary fibrous tumour is a rare differential of tumours in the sino-nasal region, diagnosed via histopathology. Although generally slow-growing, these lesions may extend the adjacent structures namely the orbit and skull base. Definitive treatment via surgical resection may be performed safely after careful radiological assessment and multidisciplinary consideration.

Evaluation of a bilingual questionnaire-based assessment on hearing in children with speech delay

@#Introduction: To correlate the score obtained using a bilingual (Malay and English) 14 points questionnaire in the detection of hearing loss at the University of Malaya, Medical Centre (UMMC), Kuala Lumpur, Malaysia over a 9 month period. Methods: This is a prospective instrument correlation study done on 93 children aged 1-4 years of age with speech and language delay for at least 3 months. Hearing status was confirmed using otoacoustic emissions, pure tone audiometry and brainstem evoked response (BSER). Hearing status was then compared to the 14-point questionnaire final scores and is statistically correlated. Results: There were 26 patients, 15 males (58%) and 11(42%) females who were diagnosed to have hearing loss. The average age of presentation was 2.49 and conductive hearing loss accounted for about 74% of cases of hearing loss. The mean questionnaire score obtained through our patients was 3.83±1.987. Discriminant analysis suggests that a questionnaire score of above 4 was indicative that the child was suffering from hearing loss. Conclusion: Our study suggests that the low-cost bilingual (Malay and English) questionnaire can be used to detect hearing loss in the Malaysian population and could potentially be useful in rural health centres to help detect hearing loss and to determine the urgency of referral to a tertiary health centre.

Electrolyte profile of Malaysian mothers' milk.

The influence of socioeconomic status (ethnicity, income, and parity) on electrolyte composition (sodium and potassium) in human milk is little known. The authors have thus quantitatively analyzed approximately 700 samples of milk (1-90 days postpartum) obtained from healthy Malaysian mothers (Malay, Chinese, and Indians) of full-term infants. Results show that the mean concentration (mmol/1) of sodium is highest 48.2 +/- 1.7; mean +/- SEM) in the Malaysian mothers' colostrum and this value decreased by 30% in their transitional milk and remained constant throughout subsequent days of lactation. Ethnically, it is found that the level of sodium in colostrum of Malay and Chinese mothers was similar but the Indian mothers' colostrum showed apparently higher value (52.7 +/- 3.4 mmpl/1) that is statistically insignificant. The transitional milk of all 3 ethnic groups studied exhibited similar levels of sodium. On subsequent days of lactation (mature milk) the Malay mothers exhibited the lowest concentration (25.9 +/- 2.6 mmol/1) of sodium that is significantly (p .05) different from that of Chinese and Indian mothers. Income and parity do not significantly affect the sodium level in Malaysian mothers' milk during all stages of lactation studied. The level of potassium, however, did not change significantly with days of lactation. Like sodium, potassium too was not influenced by income and parity.