Unilateral choanal atresia in one monozygotic twin: a case report.

Unilateral atresia is an extremely uncommon congenital disorder in monozygotic twins. We present the first case in the literature of premature, monozygotic twins with no other congenital genetic defects other than only one twin with unilateral choanal atresia on the right side, being the other sibling completely normal. Diagnostic examinations performed to both twins consisted of nasal endoscopy, which revealed only one twin with unilateral choanal atresia; axial computed tomography scan; genetic analysis; chromosome analysis; abdominal ultrasound and echocardiography. In our cases the genetic-chromosomal analysis failed to support a possible cause of unilateral choanal atresia in one monozygotic twin, suggesting a multifactorial etiology.

Acute mastoiditis complicated with bezold abscess, sigmoid sinus thrombosis and occipital osteomyelitis in a child.

Acute otitis media complications are relative rare since the introduction of antibiotics. Still many controversies exist on the diagnosis and treatment of some of them. In this report we describe a pediatric case of upper cervical abscess (bezold abscess), sigmoid sinus thrombosis and occipital osteomyelitis following mastoiditis, presenting with persistent fever and otorrhea. The patient responded well to intravenous antibiotics and wall-intact mastoidectomy. We discuss methods of early diagnosis and appropriate treatment options.

Outpatient cold knife tonsillectomy in toddlers with sleep disordered breathing.

PROBLEM: Tonsillectomy performed as day surgery has become popular over the last fifteen years. However, there are conflicting opinions regarding the safety of this practice, especially in children of very young age. We sought to determine the safety of outpatient tonsillectomy in children aged three years old and younger. METHODOLOGY: A retrospective study of all tonsillectomies performed in a major pediatric hospital during a two-year period was conducted. Age, gender, indication for tonsillectomy, other procedures performed simultaneously, seniority of operating surgeon, and reasons for hospital admissions during the first post-operative week were recorded. Patients with inappropriate records for the analysis were excluded. A total of 1058 patients were studied. Tonsillectomized children were divided into two age groups: greater than 3 years old (n = 951) and 3 years old or younger (n = 107). RESULTS: Male gender, obstructed sleep disordered breathing as indication for surgery, seniority of the operating surgeon, and age of 3 years old or younger were not associated with post-operative complications. CONCLUSIONS: Outpatient tonsillectomy can be managed safely regardless of age, as long as specific factors, such as good recovery room supervision, exist.

Evaluation of nasal mucociliary clearance after medical or surgical treatment of chronic rhinosinusitis.

An evaluation of mucociliary clearance, with the use of rhinoscintigraphy and other objectives and subjectives measures, in medically and surgically treated patients with chronic rhinosinusitis, as well in patients with or without nasal polyposis, can add to the understanding of ciliary function and its role in the pathogenesis of chronic rhinosinusitis. Thirty-four patients medically treated and 21 surgically treated (FESS) patients evaluated with rhinoscintigraphy, CT-scans, and SNOT-20. Nine of the surgically treated patients had nasal polyps and studied as a separate group. Although the various groups differ on Lund-Mackay scores (H = 11.659, P = 0.003) and SNOT-20 results (F = 26.904, P < 0.001), a statistically significant difference between mucociliary transport velocity (MTV) values could not be found. Moreover, multiple linear regression could not prove a statistically significant correlation between MTV and other variables. The various groups of chronic rhinosinusitis patients cannot be differentiated on the basis of possible nasal mucociliary clearance alternations.