Transoral laser resection of a large schwannoma in the retropharyngeal space
Published on: 26th April, 2021
OCLC Number/Unique Identifier: 9026745012
Introduction: The contents of the retropharyngeal space are limited to fat and retropharyngeal nodes. Primary tumors originating from the retropharyngeal space are rare, therefore, the existence of schwannoma in the retropharyngeal space is infrequent.
Method: This paper describes a case of a large schwannoma of the retropharyngeal space excised transorally with the use of co2 laser. This lesion measured about 6/6 x 3/5.
Result: No peri-or post-operative complications were encountered. The procedure allowed quick resumption of an oral diet and a return to normal activity for the patient.
Conclusion: This is, to our knowledge, the first report of this technique used in the excision of a large retropharyngeal space schwannoma.
Vaginal embryonal rhabdomyosarcoma in young woman: A case report and literature review
Published on: 25th May, 2020
OCLC Number/Unique Identifier: 8605988997
Rhabdomyosarcomas are the most common soft tissue tumors of childhood. They are characterized by their poor prognosis. Vaginal location is very rare after puberty and exceptional in the post menopause. Treatment is based on several therapeutic measures combining neoadjuvant chemotherapy followed by surgery and/or external beam radiation therapy. We report herein the case of a 25 years-old woman, presented with vaginal embryonal RMS revealed by metrorrhagia and pelvic pain. The diagnosis was confirmed by biopsy and histopathological study. Pre-treatment workup was negative for metastatic disease. She has received chemotherapy based on vincristine, doxorubicin, and cyclophosphamide. The clinical evolution was marked by improvement of symptoms, unfortunately the patient died following febrile neutropenia after the third cycle of chemotherapy.
A Comparative Study of Anatomic and Functional Outcomes of Two Surgical Techniques of Cataract at Lome
Published on: 17th February, 2017
OCLC Number/Unique Identifier: 7317592098
Aim: To compare the anatomical and functional outcomes of cataract surgery with manual small incision cataract surgery (MSICS) to those of extracapsular cataract extraction (ECCE) in Lome.
Patients and Methods: A prospective study involved two groups of patients who underwent ECCE (group 1) and MSICS (group 2) by the same surgeon in the same conditions in different periods. Complications and visual results to the 45th postoperative day were compared.
Results: At the 45th postoperative day, 60% of operated eyes of the ECCE group (G1) and 83.9% in the group of MSICS (G2) had uncorrected visual acuity greater than or equal to 3/10. Through the pinhole, these proportions increased to 73.3% for G1 and 92.2% for G2. Visual acuity was less than 1/10 in 4.4% for G1 and 1.1% for G2. The vitreous loss was observed in proportions of 3.8% for G1 and 3.3% for G2. During follow-up, the three main early postoperative complications were inflammation (13.9%), corneal edema (13.3%), and the pigment dispersion (7.2%) in G1 and corneal edema (9.4%), pigment dispersion (8.3%) and hypertonia (6.6%) in G 2.
Conclusion: Two cataract extraction techniques offer the same level of safety in intraoperative period. However, MSICS has certain advantages over the ECCE and would be an alternative technique in developing countries.
Efficacy of early Hyperbaric Oxygen Therapy in Central Retinal Artery Occlusion
Published on: 20th June, 2017
OCLC Number/Unique Identifier: 7317650795
A 60-year-old woman had central retinal artery occlusion (CRAO) presented to the ophthalmology department with a sudden, painless loss of vision. Her initial visual acuity was light perception and she treated with hyperbaric oxygen therapy (HBOT) 4 hours after the development of visual symptoms. Systemic risk factors were not found so she was diagnosed as having idiopathic CRAO. Her vision improved from light perception to 20/50 after the HBOT. Any complications such as neovascularization were not developed until the last follow up visit of 8th months.
Impact of Diabetes on the Nutritional Status of CKD Patients
Published on: 9th January, 2017
OCLC Number/Unique Identifier: 7317654942
Background: Prevalence of malnutrition in Chronic Kidney Disease (CKD) patients is due to their lower appetite level. Diabetic patients experience polyphagia. Hence it is necessary to understand the impact of diabetes on the nutritional status of CKD patient.
Aim: To compare the nutritious status between the CKD patients with and without diabetes.
Objectives: To find out the impact of diabetes on the nutritional status of CKD patients.
Method and Materials: A prospective random sampling method was adopted to select the subjects. Eighty CKD patients were divided equally into two groups. Tool which has been used to collect the data was SOAP format.
Results: While comparing BMI between group 1(CKD without diabetes) and group 2(CKD with diabetes) it was noticed that the percentage of normal nourished subjects in group 2 were greater than that of group1. About 63% and 25% of subjects with CKD in group1 had normal BMI and grade 1 undernourished respectively. In group 2, about 75% and 10% of patients had normal BMI and grade 1 over nourished respectively. About 80% of subjects in group 2 were on insulin treatment. About 88% of subjects in group1 were anorexic and about 55% and 25% of subjects in group 2 had polyphagia and normal appetite respectively. The difference in the energy and protein intake between the two groups was statistically significant at p<0.01 level.
Conclusions: It can be concluded from the above study that a better nutritional status was found in the CKD patients with Diabetes Mellitus (DM) than the CKD patients without DM which may be due to their normal appetite/ polyphagia, hence allowing a better food intake among group2 subjects. Weight gain in CKD with DM patients may be due to increase in fat mass which is subsequent to lipogenic effect of insulin.
Cytology and DNA Analysis of Ameloblastoma - A Case Report
Published on: 23rd January, 2017
Ameloblastoma is a benign odontogenic tumour that may have aggressive biological behavior with local recurrence and metastasis after the surgical resection. We report a case of cytology of recurrent ameloblastoma. The first tumour was diagnosed in the left mandible in 57-yers-old woman thirteen years ago. The patient was operated on, the tumour was enucleated, pathohistological diagnosis of ameloblastoma was put and DNA analysis by flow cytometry of the tumour was performed. DNA analysis showed that the tumour was diploid but proliferative. Two years after the operation, a new tumour appeared on the scar. Fine needle aspiration cytology with ultrasound guidance of the tumour was performed; cytological diagnosis of recurrent ameloblastoma was put and confirmed by pathohistology. Until now the patient is well without any new recurrent ameloblastoma.
Lincoln ’S Highway - A Forgotten Abscess
Published on: 23rd March, 2017
Introduction: Carotid space is a deep neck space within the carotid sheath. .Mosher called carotid sheath as the Lincoln Highway of the neck. Abscess in this space is rare to be seen by young Ear, Nose and Throat (ENT) surgeons in this era of early diagnosis and good antibiotics. We are reporting a case of isolated carotid space abscess in a 20 year old male to familiarize young surgeons with this abscess.
Case report: A 20 year old young boy came to our Outpatient Department (OPD) with complaints of fever, painful neck swelling, progressive difficulty in swallowing from the last 7 days. Contrast Enhanced Computed Tomography (CECT) was done which revealed abscess located adjacent to carotid artery in the carotid sheath. Incision and drainage was done and carotid sheath was opened and pus drained .Patient was discharged after few days on oral antibiotics.
Conclusion: Carotid space abscesses are rarely seen in developed countries. Tender and fluctuating swelling over the carotid artery area points towards it. CECT is the investigation of choice. Needle aspiration should be avoided especially by less trained persons. Small abscesses may respond to intravenous antibiotics but when frank and large abscess is formed, incision and drainage is the treatment of choice.
Facial Paralysıs During Varicella Zoster Infectıon in a child
Published on: 23rd March, 2017
OCLC Number/Unique Identifier: 7317595686
Introduction: Primary infection with varicella-zoster virus (VZV) results in chickenpox, characterized by viremia with a diffuse rash and seeding of multiple sensory ganglia, where the virus establishes lifelong latency. Herpes zoster is caused by reactivation of latent VZV in cranial-nerve or dorsal-root ganglia, with spread of the virus along the sensory nerve to the dermatome. Both entities have a benign clinical course in immunocompetent and young individuals. Although Herpes zoster virüs may result in Ramsey Hunt sendrom, it may rarely cause peripheral facial paralysis in the course of varicella.
Case report: A 4-year-old girl patient was admitted to the ear, nose, and throat clinic with a complaint of a rash over the body with vesicles and pustules a few days. She had left peripheral facial palsy about 2 days ago. In a general clinical examination, a few macular lesions, probably residues of vesicles, and fluid-filled blisters and pustules were observed on the back, chest, abdomen, upper, and lower limbs. She had remarkable left peripheral facial palsy. Her facial palsy was assessed as a grade II using the House-Brackmann Score. Otoscopic examination was normal and otalgia and auricular vesicle was absent. 1 mg/kg/day prednisone and 30 mg/kg/day acyclovir therapy were given to the patient due to the peripheral facial nerve palsy involvement of the VZV infection. Complete remission was achieved at 1 month after treatment.
Conclusion: Varicella-zoster virus (VZV) is one of eight herpes viruses known to cause human infection and is distributed worldwide. While the results of bell palsy are good, facial paralysis results during viral infections are severe. Cranial nerve involvement secondary to viral infection should be followed closely. The current standard of care for treatment is acyclovir and prednisone. Thus early treatment can be started in the face of developing complications and possible mortality and morbidity can be prevented.
Facial Necrotizing Fasciitis in Adults. A Systematic Review
Published on: 26th April, 2017
OCLC Number/Unique Identifier: 7317597468
Introduction: Necrotizing Fasciitis (NF) is a rapidly progressing, severe suppurative infection of the superficial fascia and the sorrounding tissues that may lead to necrosis, septic shock and death if left untreated. Facial NF is rarely seen and symptoms may be non-specific at the onset and depend on the origin site and the stage of the disease, making it difficult for diagnosis.
Materials and Methods: A systematic review was done following the PRISMA guidance. PubMed database was searched for case reports published between January 2007 and March 2017. Full text articles were obtained and assesed for relevance. Data extraction was performed as an iterative process.
Results: A total of 24 articles, describing 29 adult patients with facial NF were included. Facial NF was more common in males. Skin trauma was the most frequent mechanism of lesion and diabetes mellitus was the most common associated systemic disorder. Periorbital area was the most affected area. In order of appereance, swelling and pain were the most common initial clinical manifestations. Group A Streptococcus was the most frequent microorganism isolated. Advanced airway management was needed in more than 50% of the cases and surgical management was done in 90% of the cases.
Conclusions: Practitioners should be aware of its existance, epidemiology, etiology, risk factors and initial clinical manifestations to develop a high index of suspicion, to order studies that may discard or confirm the diagnosis, and to offer prompt treatment to preserve patient’s life and reduce the disfigurement and disability that it may cause.
Recurrent Mucoepidermoid Carcinoma of Parotid with Facial Tics - Report of an unusual case
Published on: 16th June, 2017
OCLC Number/Unique Identifier: 7317651487
We report an interesting case of a 21 year old male who presented with recurrent mucoepidermoid carcinoma of parotid with facial nerve involvement as facial tics. Intraoperatively, the tumour was noted to be firm, irregular and adherent to the underlying structures. The patient underwent extended total parotidectomy, division of buccal branch of facial nerve, selective neck dissection with cervical local rotational flap repair and post-operative radiotherapy. This presentation of Mucoepidermoid carcinoma with involvement of facial nerve as facial tics is one of the rare unique reported cases.
Investigation on the occurrence of Hairy Polyp and Choristoma in Oral Cavity: A case study
Published on: 17th August, 2017
OCLC Number/Unique Identifier: 7317627576
Hairy polyp and choristoma are rare benign developmental malformations. Hairy polyp mainly occurs in the nasopharynx whereas choristoma occurs in the dorsum of the tongue. Aetiology and pathogenesis of both hairy polyp and choristoma still remain unknown. Diagnosis is made by histological examination and complete excision is the treatment of choice. We report a case of hairy polyp and choristoma on the palate and the dorsum of the tongue respectively in a seventeen days old baby.
Otogenic lateral sinus Thrombosis: a rare complication of chronic Otitis media
Published on: 22nd August, 2017
OCLC Number/Unique Identifier: 7317596429
Since the advent of antibiotics, lateral sinus thrombosis is an infrequent complication of otitis media. Lateral sinus thrombosis may occur by thrombophlebitis or penetration by offending pathogens through the dura of middle and posterior cranial fossae. We present a case of right-sided sigmoid and transverse venous sinus thrombosis as a rare complication of chronic suppurative otitis media in an adult. We discuss the patient’s imaging, management and relevant literature to offer clinical recommendations.
A 39-year-old woman presented with headache, neck pain, vomiting, fever and photophobia with a tender right mastoid on examination. Computerised Tomography, Magnetic Resonance Imaging and Magnetic Resonance Venogram of the head revealed complete opacification of the right mastoid air cells and middle ear, with absent flow void in the right transverse and sigmoid sinus, consistent with thrombosis. After discussion with neurosurgery, she was commenced on anticoagulants. The patient was readmitted with right otalgia and otorrhea refractory to medical treatment, and ultimately underwent right mastoid exploration.
Conclusion: Lateral sinus thrombosis may occur with other intracranial or extracranial complications of otitis media. Clinicians should approach any complication of otitis media with vigilance as antibiotics may mask some signs and symptoms of mastoiditis, which can progress to otogenic brain abscess.
The management of Irvine-Gass Syndrome in a patient using Inhaler Steroid
Published on: 7th February, 2018
OCLC Number/Unique Identifier: 7355942124
Irvine-Gass syndrome, is one of the most common causes of painless decrease in vision following even uneventful cataract surgery. It usually responds well to medical therapy, but, there are no widely acceptedconsensus on the efficacy of various therapeutic options for the treatment of Irvine-Gass syndrome. The patient presenting in this case report, has systemic hypertension and chronic obstructive pulmonary disease and he use oral anti-hypertension medication and inhaler steroid. He diagnosed as Irvine-Gass syndrome due to presence of decrease in visual acuity and macular edema with hyporeflective cystic intraretinal spaces in optical coherence tomography (OCT) since4th weekcontrol visitfollowing uneventful cataract surgery. After the responsiveness of several medications including topical steroid and non-steroidal anti-inflammatory drugs and intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF), intravitreal sustained-release dexamethasone implant was applied. The visual acuity improved to 0.00 logMAR at 1st month after intravitreal dexamethasone therapy and consecutive OCT images showed complete resolution of macular edema with a normalization of the foveal profile.The visual acuity and foveal architecture remained stable in 2-year follow-up period and additional treatment was not needed. To the best of our knowledge, this is the first reportthatmentions the increment of visual acuity after a single dexamethasone implant, even though it did not response anti-VEGF combined with topical steroid and non-steroidal anti-inflammatory drugs.
Tinnitus: Diagnosis and treatment options
Published on: 31st August, 2017
OCLC Number/Unique Identifier: 7317598632
Tinnitus-derived from the Latin “tinnire” meaning “to ring” is a perceived ringing, buzzing, or hissing in the ear(s) or around the head-which has multiple etiologies and is sometimes idiopathic. As of 2009 in the United States, approximately 50 million Americans were affected for six months or greater, while a United Kingdom study in 2000 reported a 10% prevalence in the adult population [1]. Tinnitus may vary widely with regard to pitch, loudness, description of sound, special localization, and temporal pattern [2]. Most often, tinnitus is associated with other aural symptoms, such as hearing loss and hyperacusis [3]. Tinnitus may result in sleep disturbances, work impairments, and distress. The severity varies within this cohort of chronic sufferers, with some unable to fulfill daily activities. Though tinnitus is more likely to affect adults and the incidence increases with age, children can experience tinnitus as well [4]. Males are more likely to suffer as are individuals who smoke [5].
Low vision due to persistent Cloquet’s canal
Published on: 26th June, 2018
OCLC Number/Unique Identifier: 7795965841
The Cloquet’s canal (CC) is the remnant of the primary vitreous and it disappears in the intrauterine developmental period of an eye. Rarely it can persist in mature eyes and cause low visual acuity. We detected a persistent CC and low visual acuity in a 36 year-old patient. Fundus fluorescein angiography and optical coherence tomography examinations were completely normal in our case and low visual acuity was directly associated with opacification of the fibrovascular persistent CC tissue. Persistent CC can cause low visual acuity due to directly media opacity effect of fibrovascular tissue without any complication.
Kikuchi’s disease in a young Scandinavian woman
Published on: 20th September, 2017
OCLC Number/Unique Identifier: 7317601184
A 21 year-old woman presented with cervical lymphadenopathy and night sweats. Initially, lymphoma was suspected and one of the enlarged lymph nodes was excised in order to make a diagnosis. Histopathological examination revealed Kikuchi’s disease, which is usually a benign syndrome with spontaneous resolution. The disease is very rare, particularly in Caucasian populations. A higher incidence is seen in patients of Asian descent.
The patient had persistent swelling of cervical lymph nodes over several months and further lymph nodes were removed as malignant transformation was suspected. However examinations showed only Kikuchi’s disease. There was given no specific treatment. Follow-up appointments were performed biannually and the patient is currently awaiting removal of yet another swollen lymph node on suspicion of relapse of her Kikuchi’s disease.
CT signs of pressure induced expansion of paranasal sinus structures
Published on: 26th September, 2017
OCLC Number/Unique Identifier: 7317653929
Several articles have been written about hyper inflated sinus structures. Never before, however, a complete overview of all possible pressure induced variations of sinus anatomy have been published. The aim of this study was to make an inventory of the most common CT signs of hyper inflated paranasal sinus structures. During a period of 2 years all CT-scans of the paranasal sinuses made in an ENT-department were studied and the most typical shapes of hyper inflated sinus structures were recorded.
The authors documented 9 different anomalies of the anterior paranasal sinus complex (frontal sinus, frontal and supra-orbital recess and anterior ethmoid), 8 of the ethmoid and 1 of the sphenoidal sinus. These hyper inflated paranasal sinus structures can only be generated by high positive intranasal pressures. The nose blowing manoeuvre is the only manoeuvre that generates extremely high pressures and as such it might be the driving force in the generation of these hyper inflated paranasal structures and consequently play a role in the pathophysiology of chronic sinusitis.
Pneumatisation of the sinuses starts at birth and is a lifelong process. Sometimes, however, pneumatisation can be extreme and will result in facial deformities. Pneumosinus dilatans, is such a condition, characterized by an abnormal dilatation of a paranasal sinus cavity, containing air only. Most reports describe pneumosinus dilatans of the frontal sinus, but also other sinuses can show this phenomenon: maxillary sinus and in one case a unilateral pneumosinus dilatans of nearly all sinuses (maxillary, ethmoid, and sphenoid sinus) was described.
Recently Kalavagunta et al., described a less dramatic expansion of the maxillary sinus and named it “Extensive Maxillary Sinus Pneumatisation” (EMSP). They were surprised to see that EMSP has received little attention in the literature. Neuner et al., described 9 different atypical pneumatisation abnormalities of the paranasal sinus anatomy.
Most of deformities of the sinus pneumatisation are growth deformities of the thick bones that make up the frame of the sinuses. Only a few articles, deal with specific deformities of thinner bone structures such as “wavy orbital floor” and “frontal cells”. Never before, however, an article was published that studied all possible deformities due to increased pressures and tried to make a classification. So the aim of this study was to make an inventory of the most obvious pressures related deformities that can be seen on CT-scans of patients with rhinosinusitis.
The transnasal bilobed flap for medial canthal reconstruction
Published on: 6th November, 2017
OCLC Number/Unique Identifier: 7317597565
Reconstruction of the eyelids, especially medial canthal area, is one of the greatest challenges faced by the oculoplastic, head and neck surgeons. A patient with a medial canthal defect, following oncological resection involving the medial canthus, upper and lower eyelids, and nose is presented. The defect was reconstructed using a transnasal bilobed flap. The transnasal bilobed flap is a simple and effective for medial canthal reconstruction and provides in one-time reconstruction and preserves the local anatomy.
Leiomyosarcoma of Maxillary Sinus – A Rare Clinical Entity
Published on: 17th July, 2018
OCLC Number/Unique Identifier: 7795968675
Leiomyosarcoma is a malignant smooth-muscle tumor that has a predilection for the gastrointestinal and female genital tract and is a rare entity in the paranasal sinuses. It is locally fast-spreading and highly aggressive, and the prognosis is poor. We report a rare case of leiomyosarcoma of the maxilla in a patient who sought treatment for maxillary swelling, nasal obstruction with no epistaxis, orbital involvement or cervical lymph node metastasis. The patient underwent total maxillectomy followed by radiotherapy. At present after 5 years of follow up, he is symptom free with no recurrence.
An exceptional case of bilateral vestibular areflexia complicating acute otitis media
Published on: 2nd July, 2020
OCLC Number/Unique Identifier: 8627247898
Introduction: Bilateral vestibular areflexia is a rare pathological entity whose most frequent etiology is drug ototoxicity. We report an unusual case of bilateral vestibular areflexia complicating acute otitis media through which we raise the difficulties of diagnosis and therapeutic management of this pathology.
Case Report: 57-year-old Tunisian patient who consults for a loss balance associated with earache and hearing loss. Initial clinical examination revealed bilateral acute otitis media with a right harmonious vestibular syndrome and normal neurological examination. The diagnosis of post-otitis labyrinthitis was retained. The patient was put on antibiotics and corticosteroids. The evolution was marked by the persistence of instability in darkness and oscillopsia; vestibular explorations concluded with bilateral vestibular areflexia. MRI concluded to posterior labyrinthitis and eliminated central neurological involvement. The patient was kept under betahistine. The tympanic cavity was drained by a tympanic aerator on both sides. Vestibular rehabilitation was started quickly. Gradual improvement was obtained of autonomy with persistent oscillopsia.
Conclusion: Bilateral vestibular areflexia poses diagnostic problems based on anamnestic and clinical arguments and vestibular explorations. The therapeutic management is delicate, vestibular reeducation occupies a primordial place.
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