Local and regional anesthesia for functional endoscopic sinus surgery.

An effective topical and regional anesthetic technique using 25% cocaine paste combined with intravenous midazolam hydrochloride was used in 554 patients undergoing functional endoscopic sinus surgery. The operative fields were excellent and all procedures were completed with little patient disturbance. Patients recovered rapidly from sedation and were usually fit for discharge on the same day. There were no anesthetic complications. The major surgical complication rate was 0.5%.

Management of acquired cholesteatoma of the middle ear and the mastoid by combined approach tympanoplasty: a long-term view.

Mastoid cavities following surgery for cholesteatoma of the middle ear and the mastoid can be subject to recurrent infections, life-long attendance for cavity cleaning and restrictions in social activity. These problems may be avoided with a successful combined approach tympanoplasty. One hundred and forty-one patients (151 ears) treated by combined approach tympanoplasty, followed over a period ranging from 5 to 23 yr were analysed. The results are presented with an average follow-up of 14.5 yr. A fixed retraction pocket, recurrent cholesteatoma or conversion to a cavity was regarded as a failure. Failures and evidence of future failures in the form of fixed retraction pockets occurred in the first 5 yr. By not including cases with a follow-up period of less than 5 yr, we have attempted to achieve stable long-term results; 73.5% of the cases were successful. The success rate could be improved further and should provide an acceptable method of treatment.

Causes of failure of combined approach tympanoplasty in the treatment of acquired cholesteatomas of the middle ear and the mastoid.

Forty cases of failed combined approach tympanoplasty were analysed. The commonest cause of failure was adhesions between the facial ridge and the tympanic membrane, causing segmental attico-mastoid malaeration in 51.3 per cent of cases followed-up continually. Other causes were, large dermoids, incomplete removal of squamous epithelium, and eustachian tube obstruction. Eustachian tube dysfunction did not appear to be a major cause of failure.

Long-term results of total ossicular chain reconstruction using autografts.

The long-term results of 63 total ossicular chain reconstructions using autografts is presented. The follow-up period ranged from 18 months to 18 years with an average of 8.5 years. The primary aims of the study were firstly to assess the long-term success rate and to find out if there were any hitherto unknown causes of bone graft failure. In the event, it was found that the recently described anatomical variation of the oval window viz., the deep oval window, was the prime cause of failure in 32 per cent of unsuccessful cases. Some measures to help to mitigate this problem, are suggested. The result were assessed on the basis of: 1. A minimum gain of 20 dB HL in air conduction (Technical success). The success rate was 55.5 per cent. 2. Patients benefited using Smyth and Patterson's criteria in conjunction with the Glasgow Benefit Plot; 54 per cent of the patients benefited significantly.

The deep oval window.

This article presents the results of an analysis of the variable and surgically important relationship between the oval window, the fossular walls and the related posterior tympanic recesses in 50 temporal bones. The visual impressions of superficial and deep oval windows seem to correspond fairly closely to the depth of the inferior wall of the fossula fenestra vestibuli (FFV). The depth of the superior and anterior walls of the FFV by themselves, did not appear to have such a dominating relationship in determining the deep oval window. There does not appear to be a well defined posterior wall in the vast majority of the specimens (86 per cent). In the event of scar tissue forming between the superior, inferior and anterior walls, the gap between the postero-superior part of the promontory and the posterior tympanic wall (posterior communication) could allow aeration of the region of the deep oval window in such an instance. Closure of this gap by a solid shelf of ponticulus or scar tissue could cause a localized malaeration of the fossula in most cases of deep oval windows. This is an entirely new concept of the likely problems of malaeration of a deep oval window which could arise due to anatomical variations and of the possible safety valve mechanism which could prevent such malaeration and its consequences.

The fate of bone grafts in deep oval windows.

The use of bone grafts for total ossicular chain reconstructions in patients with deep oval windows may result in varying degrees of absorption of the segment of the bone graft in the fossula fenestra vestibuli. The mechanism of bone absorption is described--a condition not described before.

Unusual complication of pharyngeal pouch inversion.

A case of valvular obstruction of the oesphagus following inversion of a pharyngeal pouch is described. This complication has not been described before.

Tegmental and petromastoid defects in the temporal bone.

Fifty temporal bones were examined using the temporal bone dissecting microscope. 34 per cent were found to have defects in the tegmen and petromastoid segments, resulting in communications between the cranial cavity and the middle ear cleft. However, no defects were found in the overlying dura. This may have an important bearing on the intracranial spread of infection from the middle ear cleft, even in the absence of any bony destruction due to chronic middle ear disease.

Study of dermatoglyphics in tuberculoid leprosy

Dermatoglyphics patterns and total ridge count have been atudied in 25 cases of Tuberculoid leprosy and were compared with 25 controls. There was no statiscally significant variations in loops, whrols and total average ridge count. There were 4 (1.6%) arches in Tuberculoid leprosy as compared to 11 (4.4%) of controls and was not statiscally significant. There was more decrease of arches on the left hand of the patients as compared to the left hand of the controls.

Study of ABO Blood Groups in Vitiligo.

ABO blood groups were determined in 110 cases of vitiligo and an equal number of controls among Indian Armed Forces personnel and their dependents. Statistically there was no significant difference.

A double blind trial of terfenadine and placebo in hay fever using a substitution technique for non-responders.

A double-blind study of terfenadine and placebo in 110 patients suffering from hay fever (confirmed by skin tests) was conducted. A novel technique was applied using an escape envelope containing a reference drug which could be taken under controlled conditions if, after 48 hours, the patient experienced no relief. Significantly more patients on placebo opened the envelope than patients taking the active drug. Terfenadine was demonstrated to be an effective drug in hay fever and produced no more drowsiness than placebo.

Post-traumatic tuberculoid leprosy. (A case report).

Inoculation Tuberculoid Leprosy has been described by various leprologists off and on and this mode of onset has been established. A case of tuberculoid leprosy over thumb, appearing after trauma in an Army recruit is described with the review of the literature.

Study of non-lepromatous leprosy among Indian Armed Forces personnel.

Clinico-histopathological study of 50 cases of Non-lepromatous leprosy among Indian Armed Forces personnel is presented. Maximum cases were of Tuberculoid (TT) type. Thirty four individuals were having single lesions. Posterior aspect of elbow and medial aspect of forearm were the favourite sites. Both Indian and Ridley and Jopling classification was studied while classifying the lesions. The individuals belonged to almost all the states of India. All of them denied the history of contact with a known case of leprosy. The highest prevalent age group was between 20 to 30 years. Two cases of Tuberculoid and 3 of Maculo-anaesthetic leprosy were without involvement of nerves.

Present Day Anti-viral Therapy in Dermatology.

Attempts to develop drugs for the prevention and treatment of viral infections have faced variety of problems different firom those encoun'tered in the development of other type of antimicrobial agents. There are difficulties and consequently slow progress in the discovery of drugs which inhibit viral growth. Viruses have to strictly depend on living cells for replication. The narrow margin between the therapeutic dose of antiviral agents and lethal dose to the cells themselves is one of the major problems encountered in the development of viricidal drugs. Present day therapy in viral diseases is discussed in this paper with a review of the literature.

Symmetrical Progressive Erythrokeratoderma.

A case of symmetrical progressive erythrokeratoderma in a 32 year old male patient noticed at the age of 27 years has been described.