We report a case of a giant frontoethmoidal mucocele extending to the orbit and anterior cranial fossa. Clinically, the patient had an insidious onset of clinical presentation with no intracranial symptoms. We present its CT, MRI and histpathological features with a brief review of literature.Various surgical approaches are also discussed.
To study the effectiveness of chemical cautery with patching on chronic tympanic membrane perforations of the pars tensa. Thirty-eight patients with dry tympanic membrane perforations due to inflammatory or traumatic etiology were selected after treating the primary etiological factors like septal deviation and allergic rhinitis. Fifty percentage silver nitrate was used to cauterize the margin and the perforation was covered with thin sterile aluminium foil as a patch. A maximum number of five applications were made, and the patients were followed up for the next 5 years. In this series of 38 patients, highest success was noted among those patients with traumatic perforation, while larger perforations were reduced to small pinhole sizes which were successfully closed by myringoplasty. An overall success rate of 73.75% was achieved. This is a time tested useful method which was popularized by Derlacki (1953), to close small to moderate sized tympanic membrane perforation and should be considered as a first line management in the treatment of tympanic membrane perforation prior to any surgical intervention. Apart from being a simple and economical mode of treatment, it is associated with minimal complications. Though various materials have been used to modify this technique, the principle remains the same and the results obtained in this study is comparable with the previous ones.
Background: The objective of the study was to study the clinical presentation, microbiological profile, treatment protocol of deep neck space infections in diabetics and non diabetics.Methods: This was a prospective study conducted on 76 patients (diabetics and non diabetics) admitted in the Department of Otorhinolaryngology, TD Medical college, Alappuzha over a period of 18 months from January 2012 to June 2013.Results: The age distribution was 15-75 years. Male to female ratio was 2:1. Fever, pain, neck swelling and odynophagia were the common symptoms with dyspnoea and chest pain indicative of complications. The most common etiology was odontogenic (68.4%) followed by tonsillopharyngeal infection and foreign bodies. No etiological factor was found in 34.2%. The commonest site was submandibular space (64.2%) followed by parapharyngeal space (26.6%). Abscess was present in majority needing surgical drainage. The most common organism isolated was streptococcus viridans (37.5%). Preponderance of klebsiella species was noted in diabetics. Streptococcus showed susceptibility to pencillin (83.33%), ampicillin (92%), cefotaxime (60.526%). Klebsiella showed susceptibility to gentamicin (42.3%) and ciprofloxacin (28.57%). The complication rate was more in diabetics (34.21%). Contrast enhanced CT was done in cases suspected to have complication. The mean hospital stay was longer in diabetics (19.6 days) than non diabetics (6.4 days).Conclusions: Deep neck space infection still remains life threatening if not heeded promptly. Senescence and diabetes demand surgical intervention and meticulous glycemic control to prevent complications. Judicious use of antimicrobials and timely radiological and surgical interventions have come a long way in the management and in providing a cure to this dreaded condition.
Type 2 diabetes mellitus is a major public health problem worldwide and accompanied by enduring vascular complications, which leads to morbidity and mortality. Inflammation play major role in the pathogenesis of type 2 diabetes mellitus. High sensitivity C-reactive protein is an acute phase protein synthesized by the liver and has been revealed as sensitive, systemic inflammatory marker . Oxidative stress, low grade systemic inflammation contributes to insulin resistance and is linked to the characteristics of metabolic syndrome and type 2 diabetes mellitus. The present study was to evaluate hs - CRP, malondialdehyde (MDA) levels in type 2 diabetic patients compare with healthy controls and correlate these levels with glycated hemoglobin (HbA1C) and insulin resistance Fifty type 2 diabetic patients with age group of 35 to 45 years were selected for this study and 50 age matched healthy subjects were selected as controls. Ser um hs- CRP and insulin was assessed by ELISA, malondialdehyde (MDA) was assessed by Thiobarbituric Acid Reactive Substances (TBARS) method and other routine investigations were carried out by standardized protocols with ERBA EM-360 fully automated analyzer. The mean serum hs - CRP and MDA levels were significantly increa sed in type 2 diabetic patients com pared with healthy controls. Hs-CRP and MDA levels w ere shown significant positive correlation with glyc osylated hemoglobin (HbA1C), insulin resistance, triglycerides and negative correlation with HDL cholesterol. Elevated hs - CRP, MDA levels are potentially important diagnostic markers for the assessment of endothelial dysfunction in type 2 diabetic patients. Tight blood glucose control, regular monitoring of hs-CRP, MDA levels within normal range might be useful for reduction of vascular complications in type 2 diabetic patients.
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