Two-hole trephination (Muntarbhorn) technique for a large frontal sinus osteoma: a case report.

OBJECTIVE: To present an alternative surgical option for frontal sinus osteoma. MATERIAL AND METHOD: A woman presented with a symptomatic large osteoma in right frontal sinus. Two-hole trephination was planned to remove the osteoma using nasal endoscope and a drill in each hole. RESULTS: The osteoma was drilled and removed transnasally. Two months later, two small fragments of osteoma were detected remaining in the lateral aspect of the sinus. The fragments were removed successfully with the same technique. The patient was asymptomatic six months postoperatively. CONCLUSION: Two-hole trephination technique or Muntarbhorn technique is an attractive option for frontal sinus osteoma.

Inflammatory myofibroblastic tumor of the small intestine: a case report of a 2 month-old infant.

Benign intestinal tumors are rare in children; however, the authors describe an inflammatory myofibroblastic tumor (IMT) of the terminal ileum in a 2-month-old infant who presented with an intestinal obstruction. During laparotomy, an annular mass around the terminal ileum was resected, from which a histological diagnosis of IMT was made. A review of the literature for this rare condition was done to delineate the natural history of this tumor and to do a histological confirmation of its benign nature. Because of the risk of local recurrence, IMT cases should have a long-term follow up.

Opisthorchiasis-associated biliary stones: light and scanning electron microscopic study.

AIM: Biliary stones are frequently encountered in areas endemic for opisthorchiasis in Thailand. The present study was to describe the prevalence and pathogenesis of these stones. METHODS: Gallstones and/or common bile duct stones and bile specimens from 113 consecutive cholecystectomies were included. Bile samples, including sludge and/or microcalculi, were examined for Opisthorchis viverrini eggs, calcium and bilirubin. The stones were also processed for scanning electron microscopic (SEM) study. RESULTS: Of the 113 cases, 82 had pigment stones, while one had cholesterol stones. The other 30 cases had no stones. Most of the stone cases (76%, 63/83) had multiple stones, while the remainder had a single stone. Stones were more frequently observed in females. Bile examination was positive for O. viverrini eggs in 50% of the cases studied. Aggregates of calcium bilirubinate precipitates were observed in all cases with sludge. Deposition of calcium bilirubinate on the eggshell was visualized by special staining. A SEM study demonstrated the presence of the parasite eggs in the stones. Numerous crystals, morphologically consistent with calcium derivatives and cholesterol precipitates, were seen. CONCLUSION: Northeast Thailand has a high prevalence of pigment stones, as observed at the cholecystectomy, and liver fluke infestation seems involved in the pathogenesis of stone formation.

Histological analysis of gallbladder diseases in relation to opisthorchiasis in endemic areas of Thailand.

Chronic gallbladder disease frequently accompanies infection with the liver fluke, Opisthorchis viverrini, in Northeast Thailand. However, the pathology and pathogenesis of the gallbladder disease have not been described. Accordingly, gallbladder specimens from 187 consecutive patients who had undergone cholecystectomy at a referral hospital in an endemic area in Thailand were histologically characterized in relation to O. viverrini infection. The infection was assessed by the presence of parasite eggs in the bile and/or antibody response to the liver fluke. The average level of parasite-specific IgG was significantly higher in patients with Opisthorchis eggs in the bile than those without (P<0.001). The main histopathologic features of the gallbladder included inflammation, mucosal atrophy/or hyperplasia, goblet cell metaplasia, mucous gland hyperplasia, Rokitansky-Aschoff sinus formation, dysplasia and fibrosis. The fibrosis was strongly associated with elevated levels of Opisthorchis-specific antibody (P<0.001) but not with the presence of parasite eggs. Other pathologic features did not vary in frequency or severity with parasitological status. Our results show that severe fibrosis of the gallbladder is a more common histologic feature of cholecystitis among those with O. viverrini infection compared to those without infection. The close relationship between parasite-specific IgG and severe fibrosis suggests that specific immune response to the parasite play an important role in the pathogenesis of the fibrotic change.