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Tuberculosis (TB) is a chronic granulomatous infection which can present in an atypical form. Isolated muscle involvement is very rare. We report a 25-year-old man who presented with a massive cystic swelling on the right side of his back, extending from the lower thoracic to the gluteal region. He had a history of contact with a friend who was suspected of having TB. Magnetic resonance imaging (MRI) showed that the origin of the cyst was from the erector spinae muscles. The result of a fluid aspirate showed acid fast bacilli. The swelling disappeared after treatment with anti-tuberculous medications. Muscular involvement in TB is very rare. In our patient, the reports of an ultrasound and MRI confirmed isolated muscle and subcutaneous involvement without bony lesions. This case is reported to increase physician awareness regarding soft tissue TB. Although it is rare, similar cases may be seen in the future.

This study demonstrated that trauma patients at our hospital experience more than 3 h of delay until they reach the ED. It also identified the possible causes accounting for that delay. However, additional nationwide research is needed to establish the clear causation or association of these causes with the delay intervals.

Background: Arterial hypertension adversely affects LA size and function, effect on function may precede effect on size. This effect is reflected on patient's morbidity and mortality risks. Many techniques were used to assess LA function but with many pitfalls. The objectives: early detection of left atrial dysfunction with speckle tracking echocardiography in hypertensive patients with normal left atrial size. Patients And Methods: The study was conducted on 50 hypertensive patients and 50 age matched normotensive controls , all with normal LA size and free from any other cardiovascular disease that may affect the LA size or function. They were all subjected to history taking, clinical examination and echocardiographic study, both the conventional measures and speckle tracking then both groups were compared regarding LA strain representing LA function. Results: Our study found that hypertensive patients had significantly reduced LA function as measured by speckle tracking when compared to normotensive controls (P-value < 0.001). Also, many factors were associated with worse LA function in hypertensive patients as old age, high BMI, DM, LV diastolic dysfunction, high LV mass index, larger LA size, lower LA expansion index and higher systolic BP. Conclusion: Speckle tracking echocardiography is a useful novel technique in detecting LA dysfunction in hypertension even before LA enlargement occurs.

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Background Advanced cancer larynx and hypopharynx has high potentiality to nodal spread. Level of lymph node metastasis highly depends on site and stage of laryngopharyngeal carcinoma. Level I cervical lymph node dissection was performed to advanced laryngeal and/or hypopharyngeal tumors in this study. Results According to our statistical analysis and data, none of those thirty patients had pathologically positive level I neck lymph nodes after dissection with only one patient suffered from marginal mandibular nerve affection and three patients complained of dry mouth post-operatively, confirming the result that there is no need for prophylactic level I neck dissection in the absence of clinically palpable suspicious lymph nodes. Conclusion Although it carries relative low morbidity, there is no need for prophylactic level I neck dissection in advanced laryngeal and/or hypopharyngeal cancer patients without clinically detectable nodal metastases “N0 neck.”

Background Tympanic membrane grafting is one of the most common otological procedures. Underlay technique of tympanoplasty was described by Shea in 1960. Utech in 1959 introduce the cartilage in middle ear surgery. The search for an ideal graft material and technique for tympanoplasty was adopted by numerous contributions from surgeons all over the world. Professor Roland Eavey in 1998 introduced a transcanal inlay technique which offers advantages of surgical ease and speed as well as patient comfort. Results This study included 46 patients; 23 patients had inlay butterfly myringoplasty (group A), and 23 patients had underlay cartilage tympanoplasty. In group A, 65 % of the patients had a completely healed tympanic membrane postoperatively. Mean AB gap closure was 3.94 db. In underlay group B, 82.6% of the patients had a completely healed tympanic membrane postoperatively. Mean AB gap closure was 4.7 db. These outcomes show no statistically significant difference between both groups in terms of graft take and hearing improvement (p > 0.1). Conclusions Inlay butterfly myringoplasty is an easy, reliable, and time saving procedure that should be possible as a choice to underlay procedure. Results are comparable with underlay technique in terms of graft take rate and hearing improvement. Procedure is better regarding diminishing operative time, postoperative pain, and duration before resuming usual activities.