Anatomic variations of the paranasal sinuses in the general pediatric population

BACKGROUND

The prevalence of sinuses' anatomic variations in the healthy pediatric population has not been studied. The study describes the prevalence of known anatomic variations with regard to gender and age in this population.

METHODS

A single academic institute observational cohort study. A total of 200 head CT scans were reviewed, subdivided into five equal age subgroups (0-4.99; 5-7.99; 8-10.99; 11-13.99; 14-17 years), with an equal male to female ratio. Different subgroups were randomly assigned to two senior residents (100 CTs each). A senior rhinologist and radiologist were randomly selected to review 100 CTs each. Consensus was reached after a joint review. Each CT was evaluated for the presence of sinuses and the following variations: deviated septum, frontoethmoidal, infraorbital, posterior-ethmoid cells (Kuhn, Haller, and Onodi cells, respectively) and concha bullosa. Definitions were made according to the European Position on Rhinosinusitis 2012.

RESULTS

Gender did not affect sinus development or anatomical variations. The frontal and sphenoid sinuses were significantly less developed in the 0-4.99 years group. The point prevalence of concha bullosa and deviated septum significantly increased with age. The point prevalence of Haller cells demonstrated borderline significance among age groups, with children 0-4.99 demonstrating the lowest point prevalence. A significant association was found between the existence of Haller cells to Kuhn and Onodi cells.

CONCLUSIONS

Anatomical variations should be expected in the pediatric population. Familiarity with their point prevalence and associations may assist pediatric endoscopic sinus surgery planning.

Results of conservative treatment of volar plate sprains of the proximal interphalangeal joint with and without avulsion fracture

The prognosis of isolated volar plate sprains of the proximal interphalangeal (PIP) joint is related to the extension deficit. Some consider an associated avulsion fracture as a sign of severity. The goal of this study was to find out whether the outcomes of conservative treatment in PIP volar plate injury was impacted by the presence of an avulsion fracture. Our series included 75 patients, 27 years old on average, of which 58 were men. All sprains were stable. The X-rays were normal in 52 cases (group 1); an avulsion fracture was found in 23 cases (group 2). The patients were treated by buddy taping during the day and a straight finger splint at night for 3 weeks. At the last follow-up, no significant difference was found between the two groups regarding pain, extension/flexion range of motion or edema. The results of this study show that the prognosis of conservative treatment of PIP volar plate injuries does not depend on the presence of an avulsion fracture.

Unsuspected serious abdominal trauma after falls among community-dwelling older adults

BACKGROUND

In elderly community-dwelling patients who experience ground-level falls, fractures or brain injury are the major concern. Serious abdominal injury is seldom contemplated.

AIM

Identify all such patients presenting after a simple fall and admitted with serious blunt abdominal trauma to a single academic medical centre.

DESIGN

Retrospective chart analysis.

METHOD

All patients with both diagnoses aged 65 years or more admitted over 1 year to the department of medicine, geriatrics, surgery or urology were identified.

RESULTS

Out of 546 patients screened, three cases of ground-level falls leading to splenic rupture, isolated gallbladder rupture with gallstone ileus and perinephric hematoma were found (0.55%) and are reported.

CONCLUSIONS

Falls in elderly patients are exceedingly common mandating recognition of even rare complications. Physicians should be more aware of the possibility of occult and serious consequences of blunt abdominal trauma after falls among older adults, albeit rare.

Superior sagittal sinus thrombosis: a rare complication in a child with nephrotic syndrome

A 2-year-old boy with new-onset nephrotic syndrome developed recurrent vomiting, apathy and papilloedema. Superior sagittal sinus thrombosis was diagnosed on cranial CT and MRI. He gradually recovered after treatment with heparin, fresh frozen plasma and warfarin with complete resolution of the thrombosis after 1 month. Superior sagittal sinus thrombosis is an extremely rare complication of nephrotic syndrome in children. Early diagnosis is essential for institution of anticoagulation therapy and a successful outcome.

Potential acuity pinhole: a simple method to measure potential visual acuity in patients with cataracts, comparison to potential acuity meter

OBJECTIVE

To describe the potential acuity pinhole (PAP) test and compare its accuracy to the potential acuity meter (PAM) in predicting visual outcome after cataract surgery.

STUDY DESIGN

Prospective case series.

PARTICIPANTS

A total of 56 preoperative patients with cataracts participated.

MAIN OUTCOME MEASURES

Accuracy of predicting postoperative distance visual acuity was measured.

METHODS

Lines of inaccuracy were calculated by subtracting actual postoperative best-corrected distance visual acuity (BCVA) from predicted values. Variables analyzed were method of prediction, preoperative BCVA, and preoperative spherical equivalent.

RESULTS

The PAP test predicted visual outcomes within 2 lines in 100%, 100%, and 56% of eyes with preoperative BCVA of 20/50 and better (group 1), 20/60 to 20/100 (group II), and 20/200 and worse (group III), respectively. The PAM predictions within 2 lines for the same groups were 42%, 47%, and 0%, respectively. Mean lines of inaccuracy of PAP predictions were 0.83, 1.11, and 3.50 lines for groups I, II, and III, respectively. Mean lines of inaccuracy for PAM predictions were 2.50, 2.68, and 6.22 lines for the same groups. Differences in lines of prediction between PAM and PAP were 1.67 (P = 0.004), 1.58 (P = 0.0002), and 2.72 lines (P = 0.0001) for groups I, II, and III, respectively. There was no statistically significant correlation between PAP predictions and preoperative myopic spherical equivalent.

CONCLUSIONS

The PAP test is a simple, inexpensive, and relatively reliable method to estimate visual outcome after uncomplicated cataract surgery in eyes with no coexisting disease. It is less accurate in patients with preoperative BCVA worse than 20/200. It appears to be more predictive than PAM.

Assessment of vascularity in histological sections: effects of methodology and value as an index of angiogenesis in breast tumours

The aims of this study were to (a) determine how the quantification of blood vessels in histological sections (vascularity) is affected by the methodology used and (b) assess the value of vascularity as an index of angiogenesis by comparing tumour and normal breast tissue. Archival specimens of breast, lung and oral carcinoma, oral dysplasia and normal breast tissue were used to test the effects of the following experimental variables on vascularity: pretreatment of the sections (enzymatic digestion, heating), endothelial markers (von Willebrand factor and CD31 antibodies), method of quantification (highest microvascular density, average microvascular density and microvascular volume) and interobserver variations. All the variables examined significantly affected the estimated vascularity; this depended on the type of tissue and method used. The pretreatment of the sections before staining was the most important variable, altering the vascularity ranking of the tumours. Vascularity in breast tumours was similar to that of the normal breast intralobular stroma, suggesting that an area of high microvascular density in the tumour does not necessarily represent tumour-induced angiogenesis. Contradictory results have been published regarding the value of vascularity as a tumour prognostic factor. Our results suggest that statistically significant differences in vascularity values are most likely to arise from failure to optimize the staining protocol and from the method used to assess vascularity.

Cytokeratin expression in oral cancer and its relationship to tumor differentiation

Although cytokeratin expression is said to alter with the state of tumor differentiation, few studies appear to have confirmed this in fresh tissue biopsies from oral squamous cell carcinomas. Previous studies have been limited by the number of antibodies utilized, small sample size, or lack of information regarding tumor differentiation. A panel of 8 antikeratin antibodies (of which five recognised the simple epithelial keratins, 8, 18 and 19) were applied to fresh tissue biopsies from 24 oral cancer and 15 normal oral mucosal biopsies. A standard immunocytochemical technique was followed (Vectastain ABC method), with keratin expression graded on a 3 point scale. Our analysis indicated that simple epithelial keratins (K8, K18, K19) were not confined to the more poorly differentiated tumors. This may be relevant to tumor prognosis.

An analysis of mandibular fractures in Dundee, Scotland (1977 to 1985)

A retrospective study was undertaken to assess mandibular fractures presenting over the period 1977-1985 in Dundee, Scotland. The data collected included age, sex, aetiology, month in which injury occurred, anatomical site of fracture, associated maxillofacial trauma and treatment modalities. The majority of fractures were sustained by males in the age group 20 to 29 years. Assault was the major cause of trauma followed by falls and road traffic accidents. The posterior body region was found to be the most common fracture site in the mandible. The level of such trauma has more than doubled, since a similar study was undertaken between the years 1961 to 1970.

Acanthamoeba keratitis. Potential role for topical clotrimazole in combination chemotherapy

Clotrimazole is an antifungal agent that has been shown to have excellent in vitro activity against most strains of Acanthamoeba. We encountered four patients who developed Acanthamoeba keratitis while wearing contact lenses that had been stored in homemade saline. Their medical treatment regimens included the use of topical 1% clotrimazole. In two patients in whom conventional therapy failed, clotrimazole was successful in controlling recurrent infection following penetrating keratoplasty. Two other patients were treated with clotrimazole as well as propamidine isethionate and neomycin sulfate-polymyxin B sulfate-gramicidin from the outset, and had an excellent response to medical therapy. In those patients who found the commercially available cream uncomfortable, a 1% clotrimazole suspension formulated in artificial tears was used and found to be well tolerated.

Are post-operative radiographs necessary in the management of simple fractures of the zygomatic complex?

Post-operative radiographs are usually requested, as an adjunct to clinical judgement, in the management of fractures of the facial skeleton. Unfortunately exposure to X-irradiation is not without risk. The request for radiographs should, therefore, be justified in every case. In this retrospective survey involving 183 simple fractures of the zygomatic complex, all treated via a Gillies temporal approach, only one required a further operation, under the criteria described. The findings in this study might be taken as evidence that clinical judgement alone is sufficient for post-operative evaluation and as such offers a challenge to the accepted protocol of requesting post-operative radiographs in such cases.