Double-chambered right ventricle: Magnetic resonance imaging findings

Primary double-chambered right ventricle is an uncommon congenital anomaly that presents with right ventricular outflow tract obstruction in childhood or adolescence. A search of the literature revealed only a few documented case reports with MRI findings. We present a case with mixed lesions, and with anomalous muscle bundles located both in the middle portion of the right ventricular sinus and at the subinfundibular level.     

Management of congenital preauricular sinuses 5 years experience

Symptomatic congenital preauricular sinus need surgical excision. Different, approaches had been described for removal. A retrospective study of files of 25 patients operated in King Abdul Aziz University Hospital showed that the chance of leaving epithelial remnant is common when using the standard technique especially those patients who had prior abscess or surgical intervention. The supraauricular approach described by Prasad, offers a better chance for total excision of the sinus and its tract.     

Recurrent thyroid abscess — Is it a fourth branchial archanomaly?

Branchial fistulae are of congenital origin⁶ and consists of skin lined tract opening internally at junction of cartilaginous and bony meatus in case of 1^st arch anomaly, tonsillar fossa in case of 2^nd arch, while 3^rd and 4^th arch sinuses have internal opening at level of pyriform sinus or below. A complete tract of 3^rd or 4^th arch fistulae is yet to be described. Fourth arch fistulae¹ have a distinct clinical pattern of internal opening at pyriform apex, are left sided and associated with suppurative thyroiditis³, they manifest at a younger age and treatment involves excision of tract with ipsilateral thyroid lobectomy.     

A rare case of primary nasoethmoidal meningioma

Meningiomas of sinonasal tract is a rare entity especially in children. Primary sinonasal meningiomas often pose difficulty in diagnosis because of their infrequent occurrence and clinically they appear to be nasal polyp. The final diagnosis rests on the histological examination. Extra cranial meningiomas are rare in children and tend to be more aggressive. Here a case of primary ethmoid sinus meningoma with extension into the nasal cavity is presented and despite of its aggressive behavior it was benign. The importance of complete surgical extirpapion is undoubted and results in a good survival rate. Histological grading of the tumour is not crucial in predicting the rate of recurrence. The paucity of reported cases is the evidence for its rarity.     

Selecting the Best Approach to the Frontal Sinus

The Messerklinger technique is an endoscopic approach to sinus surgery designed to be minimally invasive and preserve mucosa and hence physiological function. More recently there have been advocates for more radical endoscopic approaches to the frontal sinus such as the Modified Lothrop. This review discusses different approaches to frontal sinus surgery including any advantages and disadvantages to each approach. After examining the evidence from the literature, meticulously performed endoscopic frontal sinusotomy with or without computer guidance appears to be the most effective minimally invasive procedure for treating chronic frontal sinusitis secondary to outflow tract obstruction. Properly performed, it is almost always effective in dealing with even the most diseased frontal sinus. It offers clear advantages in reducing complications and recurrence rates in frontal sinus disease, even for revision cases.     

Sinonasal neuro endocrine carcinoma extending into orbit — a case report

Small Cell Neuroendocrine Carcinomas of the Sinonasal tract are extremely uncommon and distinct neoplasms with aggressive clinical behavior. They have similar morphological and immunohistochemical features to those of small cell carcinomas of the lung. They should be distinguished from Olfactory Neuroblastomas. We report a case of this rare entity. A 46-year-old woman presented with a history of injury to the right eye with facial pain and proptosis as the primary symptoms. Later she developed nasal stuffiness. C.T. Scan revealed a space occupying lesion in the right nostril extending into ethmoid sinus and orbit. Functional endoscopic sinus surgery was done with decompression of the orbit. The biopsy material was obtained from ethmoid sinus and orbit. Histopathological examination of the biopsy specimen along with Immunohistochemical stains confirmed a Small Cell Neuroendocrine Carcinoma. Patient was treated with Radiotherapy and chemotherapy and responded well.     

Locally invasive nodular lymphoid hyperplasia: Radiological findings in a case of pulmonary and sinus disease

Nodular lymphoid hyperplasia is a rare, benign, lymphoproliferative disease usually found in the gastrointestinal tract. It has never been reported in the sinuses. We present an unusual case of pulmonary nodular lymphoid hyperplasia with locally invasive sinus involvement and describe the CT, MRI and positron emission tomography findings.     

A case of metastases to the paranasal sinus from rectal mucinous adenocarcinoma

Metastases of malignancies to the sinonasal tract are rare. We report a case of metastases to the paranasal sinus from rectal adenocarcinoma. A 72-year-old woman, who had a history of therapy with rectal adenocarcinoma, came to our hospital for visual loss in her right eye. Computed tomography revealed soft tissue in the right paranasal sinus. She underwent endoscopic sinus surgery immediately and an easily bleeding tumor was found in the paranasal sinus. Magnetic resonance imaging showed a mass involving the posterior ethmoid, the sphenoid sinus, and the orbit. From the surgical specimen, we found that the tumor was a metastasis of a previously managed rectal mucinous adenocarcinoma. Metastatic carcinomas of the sinonasal tract have a high risk of heavy hemorrhage during endoscopic sinus surgery. When a patient with visual loss has a history of malignancy, a possible metastatic tumor should be considered before surgery.     

Tuberculous granuloma in haemangiomatous nasal polyp

Tuberculosis of upper respiratory tract is quite infrequent especially the nasal involvement. Isolated cases have been reported by certain authors. A ease of nasal tubercolosis is being presented for its rare site and its association with haemangioma.     

Verrucous carcinoma of the frontal sinus: A case report and review of the literature

Carcinoma of the frontal sinus is rare. Treatment is controversial, and prognosis is poor, The etiology is unknown, although some risk factors for other paranasal sinus carcinomas have been identified. A 70-year-old male presented with proptosis and x-ray findings consistent with a mucocele of the frontal sinus. At operation the patient was felt to have a cholesteatoma. Pathologic diagnosis was verrucous carcinoma of the frontal sinus. The case is discussed and the literature is reviewed.     

Upper ureteropyeloureteroanastomosis in obstruction of the ureter of the lower half of the double kidney

A new surgical technique is presented for treatment of affected ureter of the lower half of the double kidney consisting in lumbotomy, mobilization of the kidney and both ureters, followed by cutting off the ureter of the lower half of the double kidney from the pelvis and removal of the ureter. The ureter of the upper half is crossed at the distance of 5 cm from the pelvis and anastomosed with the pelvis of the lower half of the double kidney, its distal part is sutured with the lower part pelvis by Andersen-Hynes. As a result, two wide anastomoses of the proximal and distal parts of the ureter of the upper half of the double kidney with pelvis of its lower half is created. Drainage of the connected urethra is conducted separately with nephrostomic drainage, intubator and stent. Such surgical aid allows urine flow from both halves of the double kidney along one unaffected ureter of its upper half. Two women were operated by the above technique: a 53-year-old woman had iatrogenic lesion of the ureter of the lower half of the double kidney causing its extended defect; the other 21-year-old woman had a vesicoureteral reflux to the lower half of the kidney. Urodynamics of the upper urinary tract recovered in both the patients. Thus, upper ureteropyeloureteroanastomosis in complete doubling of the upper urinary tract and obstruction of the ureter of the lower half of the kidney reestablishes adequate urine outflow in the above anomaly by the unaffected ureter.     

Mature posterior fossa teratoma mimicking dermoid cyst

We describe a very rare case of mature posterior fossa teratoma in an adult who presented with clinico-radiological findings consistent with a dermoid cyst. A computed tomography scan showed a hypodense mass in the cistern magna with calcification and a sinus tract in the occipital bone. Magnetic resonance imaging revealed a hypo- to hyperintense mass without contrast enhancement. The intraoperative picture showed a dermal sinus and a cyst containing lipid, keratin and hair. Histopathological examination showed a tumor with components of all the three germ layers; thereby, a diagnosis of mature teratoma was made. The histopathological differentiation between teratoma and dermoid cyst is very valuable for ruling out the presence of immature/malignant or germinomatous components that would require further adjuvant therapies. Thus, we here present a rare case of posterior fossa teratoma mimicking dermoid cyst and emphasize the importance of histopathological differentiation between these entities.     

髋关节置换术后假体周围感染的窦道冲洗置药治疗18例报告

目的探讨通过窦道冲洗置药治疗髋关节置换术后假体周围感染的临床效果。方法2005年9月至2011年9月,安徽省立医院和安徽省第二人民医院收住全髋关节置换术后假体感染的患者18例,患者早期感染为7例,中期感染8例,晚期感染3例,患者均无明显发热,引流液均行培养和药敏检查,均培养出细菌。采用无菌管通过窦道置人关节腔,分别使用生理盐水,过氧化氢进行反复冲洗,根据药敏试验选择敏感抗生素通过无菌管置入关节腔,并保留无菌管用作引流,根据引流量决定冲洗置药次数。换药后嘱患者持拐下床活动,后期引流量较少,细菌培养3次阴性,冲洗置药后可拔出无菌管,随后窦道可愈合。治疗中定期复查血常规,生化,C反应蛋白（CRP）,血沉（ESR）。保持较好营养状态。结果18例经3周治疗,窦道愈合,髋关节Harris评分由术前平均35．8分提高到术后70．6分,血常规恢复正常,CRP平均在30mg／L,ESR平均在35．6mm／h。除1例因医疗纠纷选择手术取出假体外,其余17例临床效果满意。结论对于部分全髋关节置换术后假体感染病情平稳的患者,通过加强营养,使用无菌管通过窦道置人关节腔进行反复冲洗,根据药敏试验选择敏感抗生素通过无菌管置入关节腔,可达到窦道愈合,髋关节功能恢复的效果。     

Acquired Pelger-Huet anomaly in erythroleukemia

The Pelger-Huet anomaly was found in association with erythroleukemia in a 62-year-old female who was known to have had normal granulocyte morphology 9 months previously. This is the third reported case of the coexistence of Pelger-Huet anomaly with erythroleukemia and the first case in which normal morphology was known to have been present prior to the development of erythroleukemia. Although the pseudo-Pelger-Huet anomaly has been reported in association with numerous neoplastic and non-neoplastic hematologic diseases, its pathogenesis and the clinical significance of its presence remain to be elucidated.     

Second primary carcinomas in patients with squamous cell carcinoma of the maxillary sinus

Three hundred fifty-one patients with squamous cell carcinoma of the maxillary sinus received radiation therapy between 1953 and 1984. Nine subsequently developed cancers in other organs than the maxillary sinus, and five squamous cell carcinomas occurred in the second maxillary sinus. Analysis by the person-year approach suggested a remarkably increased risk of 67 times for second sinus cancer and no additional increased risk of cancers to other organs, such as the upper aerodigestive tract.     

Persistent Left Superior Vena Cava in Hematological Malignancy Requiring Central Venous Catheter Insertion for Intensive Chemotherapy

Persistent left superior vena cava is a congenital vascular anomaly, which is possibly arrhythmogenic and thrombogenic, rarely complicated with coronary sinus atresia. We treated a 42-year-old male with Hodgkin''s lymphoma requiring central venous catheter placement for intensive chemotherapy. Persistent left superior vena cava was revealed after the insertion of the central venous catheter by the radiological finding of the catheter tip cannulated into the vena cava cavity. The relationship between coronary sinus atresia and persistent left superior vena cava induced by central venous catheterization remains unclear; however, the hematologist should pay attention to the malpositioning of the central venous catheter.Key Words: Persistent left superior vena cava, Coronary sinus atresia, Central venous catheter, Chemotherapy, Hematological malignancy     

Malignant schwannoma of the sinonasal tract

Malignant Schwannoma of the sinonasal tract is an extremely rare tumour. So far, only 19 cases have been reported in the literature. We report herein a case of malignant schwannoma involving nasal cavity, maxillary antrum and ethmoid sinus in a 60-year-old male patient. The patient was treated with surgery and post-operative radiotherapy. He currently remains free of the disease 15 months after the diagnosis and twelve months after completing therapy.     

Congenital coronary artery anomalies: diagnosis with 64 slice multidetector row computed tomography coronary angiography: a single-centre study

Retrospective review of the congenital coronary artery (CA) anomalies detected by a 64-slice multidetector row computed tomographic (MDCT) angiography. The type of the anomaly, imaging characteristics, clinical relevance and the superiority of the MDCT over conventional coronary angiography are discussed. Multidetector row computed tomographic coronary angiography was carried out by the usual technique with 70 cc of non-ionic contrast agent and retrospective electrocardiogram gating. The volume data obtained were reconstructed in axial plane, along with volume-rendered three-dimensional reconstruction and virtual angioscopy in selected patients. The images were analysed by a radiologist, experienced in cardiac CT, and an experienced cardiologist. A retrospective review of the records was carried out, and subjects with congenital coronary anomalies were included in the study. Between 15 November 2005 and 27 February 2007, 1495 MDCT coronary angiograms were carried out. Eleven of them were found to have coronary anomalies. Five had absent left main CA. Two had interarterial course of the left main CA artery passing in between the right ventricular outflow tract and the root of aorta. In one patient, there was aberrant origin of right CA from the left aortic sinus with subsequent interarterial course and another one had aberrant origin of circumflex artery from the right aortic sinus. One patient each of congenitally absent circumflex artery and atresia of the right CA were found. Sixty-four slice MDCT coronary angiography provided accurate depiction of anomalous vessel origin and course along with the complex anatomical relation with the adjacent structures. CT can be considered as a first-line imaging method for delineating coronary arterial anomalies.     

Primary carcinoma of the frontal sinus

Malignant Tumours of frontal sinus are very rare. Two cases of primary carcinoma of the frontal sinus, with infiltration into the eye ball in both the cases and into the brain in one of the cases, are presented. The relevant literature has been reviewed.     

国产肿瘤型膝关节假体翻修术的临床疗效与相关诊治策略

目的 分析肿瘤型膝关节假体置换术后翻修手术的原因与围手术期的相关注意事项,提高翻修术的临床疗效.方法 回顾分析2001年1月-2009年1月间完成13例肿瘤型膝关节假体翻修手术.男9例,女4例.平均年龄45.3岁.股骨远端11例,胫骨近端2例.骨巨细胞瘤9例,骨肉瘤3例,骨韧带样纤维瘤1例.原肿瘤假体均为国产,铰链膝关节10例,旋转铰链膝关节3例.翻修手术时间为首次手术后1-29年.翻修手术原因11例为假体无菌性松动,3例为假体松动伴窦道形成,2例伴有假体断裂.翻修手术前肢体功能平均评分16.7.翻修手术时6例应用原假体,4例将原铰链膝关节更新为旋转铰链膝关节;3例单纯更换假体的松动部分.3例合并窦道的患者均行一期翻修手术.结果 所有患者的切口均一期愈合并获得随访,最长为8年,最短为1年,平均为3年4个月.1例骨肉瘤患者于翻修术后1年因肺转移死亡,12例无瘤生存.10例无窦道的患者中1例于术后5年发生假体再松动,余未发生与假体有关的并发症.3例合并窦道一期翻修的患者中,1例术后7年无异常,2例因感染复发而行截肢手术.11例保留住肢体的功能评分平均为23.6分.肢体长度较翻修术前无明显变化.结论 肿瘤型膝关节假体翻修术的主要原因为假体无菌性松动、感染和假体断裂.翻修术前应依据患者病情决定手术的具体方式;合并窦道的患者应行二期翻修术;肿瘤假体松动诊断一旦确立,应及时行翻修手术,可获得令患者满意的肢体功能,但肢体的长度无法改变.