Successful treatment of tumour-induced osteomalacia after resection of an oral peripheral ossifying fibroma.

Tumour-induced osteomalacia is a paraneoplastic syndrome wherein bone is affected by a hormone from a tumour that causes renal phosphate wasting and hypophosphataemia. Here, we present the case of a 31-year-old man who has been suffering from generalised bone pains and a spine deformity that led to loss of height. Pertinent findings are low serum phosphorus, low vitamin D and decreased bone mineral density. These findings led to a diagnosis of osteomalacia. However, the finding of an oral mass raised some questions as to what role it plays in the patient's disease. It was suspected that the oral mass (fibroma) was producing a hormone that led to renal phosphate wasting, hypophosphataemia and then osteomalacia. This hypothesis was proven after surgical removal of the mass led to normalisation of the metabolic derangements and eventually led to a resolution of the bone pains.

Validity and Reliability of the Filipino Reflux Symptom Index.

OBJECTIVES: This study aimed to establish validity and reliability of the Filipino Reflux Symptom Index (FRSI) and to test it among patients with laryngopharyngeal reflux (LPR) before and after 6 months' trial of rabeprazole. STUDY DESIGN: A case-control study was carried out. METHODS: There were 35 LPR patients and 30 controls who were twice-administered the FRSI and Filipino Voice Handicap Index (FVHI) for test-retest reliability, and videostroboscopy was performed to obtain baseline reflux finding scores (RFSs). Patients took rabeprazole 20 mg twice daily for 6 months. The FRSI and FVHI were readministered a third time, repeat videostroboscopy was performed, and repeat RFS was obtained. Reliability, validity, and internal consistency were computed. RESULTS: A total of 58 participants, 29 patients and controls each, aged 22-65 years completed the study. FVHI 2:1 and FRSI 2:1 significantly correlated with no significant differences between FRSI 2:1. FRSI had good item-total correlations indicating psychometrically sound items. There were significant differences between patients and controls for FRSI scores and mean scores. FRSI 3 scores were significantly lower than FRSI 1 scores, suggesting symptoms improved after treatment. There were no significant differences between RFS 2 and 1. Significant differences between FRSI 3 and 1, but not between FVHI 3 and 1, suggest the FRSI was more sensitive to changes in reflux after 6 months' intervention than the FVHI. CONCLUSIONS: The FRSI is a valid and reliable tool for assessing LPR symptoms and may be used for primary care screening among Filipinos. Initial response to a 2-week empirical proton pump inhibitor trial may support an impression of LPR; non-response warrants specialist referral for further investigation.

Medical education: Effectiveness of two simulation teaching methods in developing intubation skills of year level six medical students (clinical clerks)

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To describe outcomes of two simulation teaching methods in developing intubation skills of year level six medical students (clinical clerks).<br /><strong>METHODS:</strong> Students were shown a 6-minute video on intubation. Students were exposed to video-assisted learning, video-assisted learning with instructor-guided simulation, and video-assisted learning with experiential learning. Each student was assessed by a non-graded 11 point objective structured clinical examination.<br /><strong>RESULTS AND DISCUSSION:</strong> The three learning strategies: 1. Video-assisted learning, 2. Video-assisted learning with instructor-guided simulation, 3. Video-assisted learning with experiential learning (self-discovery learning) simulation showed OSCE mean scores (standard deviations) of 5.76 (2.16), 7.21 (2.35) and 7.60 (1.72), respectively. Failure of intubation was 21% (8/38), 2% (1/40) and 0% (0/36), respectively. There is an absolute risk reduction of 27-30% in failure of intubation when either VGL or VEL is used. Students recognized the contribution of the simulation-based activities to the development of their intubation skills. They appreciated the opportunity to actually perform intubation in a rehearsal setting before doing the procedure on real patients.<br /><strong>CONCLUSION:</strong> Medical simulation enhanced student skills development. Experiential learning or self-discovery learning method may be as effective as instructor guided simulation.</p>

Extended transpalatine approach for excision of juvenile angiofibroma

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To describe the extended transpalatine approach (ETPA) with transection of the ipsilateral greater palatine artery and extension of the ipsilateral retromolar incision and its corresponding surgical outcomes and present it as an option in the excision of juvenile angiofibroma (JA).<br /><br /><strong>METHODS:</strong> <br /><strong>Design:</strong> Descriptive case series<br /><br /><strong>Setting:</strong> Tertiary Public University Hospital<br /><br /><strong>Subjects:</strong> 13 JA cases undergoing ETPA<br /><br /><strong>RESULTS:</strong> Records of JA in a tertiary hospital from 2007 - 2013 were reviewed. Out of 35 JA patients, 13 underwent excision via extended transpalatine approach. Preoperative work-up included CT scan with contrast with or without preoperative embolization. In all patients, the wide field allowed easy tumor excision and facilitated inspection and hemostasis. There was only one recurrence in our series compared to 1 each for 4 endoscopic and 18 transmaxillary approaches. Not one of the patients developed a fistula or hypernasal speech. All patients had minimal palatal scarring, symmetric alveolar growth and palatal function.<br /><br /><strong>CONCLUSION:</strong> The ETPA is a robust technique. It provides good exposure of JA with minimal preoperative requirements and postoperative complications.</p>

Prevalence of early laryngeal cancer and benign vocal cord pathology among patients undergoing videostroboscopy in Philippine General Hospital from 2008 to 2010

OBJECTIVE: To determine the types and prevalences of laryngeal pathology among patients undergoing videostroboscopy in the Philippine General Hospital. METHODS: A systematic review of videostroboscopy records patients from January 2008 to December 2010 was perform Demographic data, risk factors, diagnosis and their associat were determined. RESULTS: The following vocal cord pathologies were recorded the 507 subjects who underwent videostroboscopy during assessed time period: vocal cord nodules (17.4%) laryngopharygeal reflux (16.6%), vocal cord paralysis (12.8%) cyst (10.5%), polyp (8%) and laryngeal cancer (6%). Vocal cord nodules were found to be more common among professic voice users (odds ratio = 2.8). Risk factors found to be associated with cancer development include age, gender (male, odds ratio 19.8) and smoking history (odds ratio = 12.7). CONCLUSION: The most common laryngeal pathology among patients undergoing videostroboscopy is vocal cord nodules. One out of 20 patients who underwent the procedure was given a diagnosis of laryngeal cancer.

The recurrent laryngeal nerve in relation to the inferior thyroid artery in adult Filipino cadavers

@#<p style="text-align: justify;"><strong>OBJECTIVE</strong>: To describe the anatomic relationship of the recurrent laryngeal nerve and the inferior thyroid artery in adult cadavers in the Philippines and to compare the proportions of these anatomic relationships with those reported in the foreign literature.</p> <p style="text-align: justify;"><strong>METHODS</strong>:<br /><strong>Design</strong>: Descriptive, cross-sectional<br /><strong>Setting</strong>: University of the Philippines College of Medicine Anatomy Laboratory<br /><strong>Subjects</strong>: Fifty-four (54) preserved cadavers (108 sides) dissected within a period from June 2008 to Aug 2010. The anatomy and position of both the right and the left recurrent laryngeal nerves (RLN) and inferior thyroid arteries (ITA) were noted. The RLN was further classified into two variations: non-branching or branching prior to insertion at the cricothyroid joint under the inferior constrictor muscle. The ITA was also classified into non-branching and branching. The results were compared to two foreign studies using a Z-test for two proportions.<br /><br /><strong>RESULTS</strong>: Fifty four (54) cadavers (108 sides) were dissected. Among the cadavers, both the recurrent laryngeal nerves and inferior thyroid arteries had a maximum of two branches although both the RLNs and ITAs for both the right and left sides were mostly non-branching. The right side of one cadaver was noted to have both a branching RLN and a branching ITA. There were no non-recurrent laryngeal nerves seen among the 54 cadavers. For both left and right sides, the RLN was mostly dorsal to the ITA. Branching RLNs was mostly dorsal to a non-branching ITAs. Most of the non-branching RLNs were dorsal to the ITAs. Non-branching RLNs were usually dorsal to the ITA. The local patterns of the course of the RLN in relation to the ITA approximates those of Chinese where there is predominance of the RLN dorsal to the ITA but differs from those of Brazilians where the RLN is usually between ITA branches.<br /><br /><strong>CONCLUSION</strong>: There are multiple anatomical variations regarding the relationship of the RLN and the ITA. The anatomic variation among Asians may be different from Brazilians. The surgeon's knowledge of the possible various configurations of the RLN and ITA should be able to help in identification and preservation of the RLN and prevention of complications in thyroid surgery.</p>

Probabilities of ossicular discontinuity in chronic suppurative otitis media using pure-tone audiometry.

OBJECTIVE: To analyze the likelihood ratios (LRs) and predictive values of preoperative air-bone gap (ABG) levels on the presence of gross ossicular discontinuity (OD) among chronic suppurative otitis media (CSOM) patients. SETTING: Tertiary hospitals. METHODS: Records of 276 patients with CSOM 7 to 75 years old undergoing their first tympanomastoidectomy were reviewed. Association of preoperative audiogram on the presence of OD was analyzed using logistic regression analysis and chi 2 tests. Frequency-specific ABG values were compared with the presence of OD. RESULTS: In CSOM without cholesteatoma, the ABG of 20 dB or less at 500 Hz (LR [-], 0.119; 95% confidence interval [CI], 0.016-0.867) and 30 dB or less at 1 kHz (LR [-], 0.276; 95% CI, 0.087-0.876) decreased probability of OD from 33 to 5.6% and 15.5%, respectively. Air-bone gap levels of greater than 30 dB at 2 kHz (LR [+], 2.8; 95% CI, 1.4-5.9) and greater than 40 dB at 4 kHz (LR [+], 2.2; 95% CI, 1.2-3.9) increased the probability of OD from 33 to 51 to 89%. In the presence of cholesteatoma, the chance of OD was 88%. The ability of ABG to alter probability of OD was not significant in the presence of cholesteatoma. CONCLUSION: Narrow ABG at lower frequencies suggested absence of OD. Wide ABG at higher frequencies suggested presence of OD. Simple tympanoplasty can be done to patients with a small chance of OD as assessed by pure-tone audiometry, whereas a mandatory exploration of the ossicular chain with possible reconstruction was suggested on subjects with a high chance of OD. The presence of cholesteatoma warrants ossicular chain exploration.