Pediatric invasive sinonasal Scopulariopsis brevicaulis--a case report and literature review

Objective

Acute invasive fungal sinusitis (AIFS) appears mainly in immunocompromized patients and may be caused by various pathogens. We describe a teenager with invasive sinonasal Scopulariopsis brevicaulis and review all the reports on this rare pathogen.

Methods

A literature search on Scopulariopsis sinonasal invasive infections was performed and clinical data including age, gender, co-morbidities, treatment and prognosis was collected on all the patients.

Results

A 17 years old boy with acute myelocytic leukemia and Scopulariopsis brevicaulis sinonasal infection was successfully treated at our department with a combination of extensive surgical debridement and antifungal antibiotics. We found six articled describing six patients with AIFS due to Scopulariopsis species. Four patients were adults and two were children, 3 males and 3 females. Two had an infection with Scopulariopsis acremoium, one with Scopulariopsis candida and for 3 patients no data was given on the specific Scopulariopsis species. All the patients except one were immunocompromized. One patient was treated with antifungal drugs, 2 with surgery and 4 patients received antifungals and were operated. One patient died due to the fungal infection and two patients died due to other causes.

Conclusions

Scopulariopsis AIFS is a life threatening disease affecting mainly immunocompromized patients, both children and adults. No clear treatment regimen has been established yet. We describe the first case of a teenager with Scopulariopsis brevicaulis sinonasal infection treated successfully with a combination of wide local excision and antifungal therapy.     

Huge extracranial asymptomatic frontal invasive meningioma: a case report

Meningioma is a well-recognized tumor of the central nervous system, but it rarely appears as an extracranial tumor secondarily extended into the paranasal sinuses. Meningiomas arise from arachnoid cap cells that form the external membrane of the brain. Most meningiomas are slow growing and are usually not associated with substantial underlying brain edema; they cause symptoms by the compression of adjacent neural structures. An interesting natural history of a neglected meningioma with extracranial extension is described. The diagnosis of meningioma was established by CT imaging, finally based on the histopathology and immunochemistry. The meningioma cells in our male patient were positive for progesterone receptors. The patient underwent surgical treatment and recovered without complications. On follow-up 1 year later there were no signs of process expansion.     

Treatment of dysarthria: a case report.

There is little information available to the speech clinician on management of dysarthria. This article presents the rationale, procedural outline, and results of an approach to communication training for one dysarthic subject in view of suggestions made by Darley et al. (1975).     

毛霉菌感染的慢性侵袭性真菌性鼻窦炎眶内侵袭一例

患者女,80岁.2007年3月12日以左侧面部疼痛伴局部麻木3个月,左侧眼球上移伴复视1个月为主诉入院.糖尿病史18年.     

Acute invasive fungal rhinosinusitis--case report

A case report of acute invasive fungal rhinosinusitis in 28 year old woman with acute myeloid leukemia is described in this paper. The diagnosis of the fungal disease was based on clinical presentation, endoscopic evaluation of nasal cavity, computed tomography and magnetic resonance imaging of the paranasal sinuses and histopathological findings. An aggressive treatment including antifungal therapy (amphotericin B), antibiotics and the surgery of paranasal sinuses was implemented. Unfortunately the underlying disease and the fungal invasion progressed rapidly and the patient died on the forth week post-op due to cardiorespiratory failure.     

头颈部外伤性假性动脉瘤的处理(附4例报告)

目的:探讨外伤性假性动脉瘤的临床表现、诊断及治疗方法。方法:回顾性分析4例外伤性假性动脉瘤的不同处理方法及其随访结果。结果:本组病例均有明显的外伤史,DSA、CT检查可确诊,对于位置与大小不同的外伤性假性动脉瘤,2例行放射介入治疗,2例行手术治疗,疗效良好。结论:头颈部外伤性假性动脉瘤比较罕见,结合放射技术,诊断并不困难;治疗方面适合进行放射学介入治疗的应优先选择介入治疗,必须行手术治疗的患者可在切除动脉瘤的同时尽量缝合血管壁,保持血流通畅,减少并发症。     

Tracheocele--a case report

A tracheocele is a rarely encountered entity that may be congenital or acquired. This tracheal lesion is characterized by the presence of a single cystic pouch filled with air or a mixture of liquid and air. We recently managed a case of a large voluminous acquired tracheocele originating from the right posterolateral tracheal wall. A 39-year-old male patient presented with chronic cough and breathy voice. Rigid laryngoscopy revealed a right immobile vocal fold. Computed tomography scan revealed a tracheocele that was excised externally with recurrent laryngeal nerve preservation.     

Treatment of anterior benign paroxysmal positional vertigo by canal plugging: a case report

A 75-year-old man with incapacitating anterior canal benign paroxysmal positional vertigo (BPPV) was relieved of symptoms following anterior semicircular canal occlusion using a transmastoid approach. The preoperative symptoms were similar to those of posterior canal BPPV. The preoperative findings on Dix-Hallpike's maneuver were a paroxysmal torsional nystagmus with a down-beating component that increased when the patient's gaze was directed towards the affected ear. The most provoking head movement for the vertigo/nystagmus was Dix-Hallpike's maneuver with the affected ear lowermost.     

Treatment of invasive aspergillus sinusitis with liposomal-amphotericin B

Invasive sinonasal aspergillosis is a severe and frequently fatal infection in immunosuppressed patients with hematologic malignancies. Seven patients with sinonasal aspergillosis who failed to respond to conventional amphotericin B (AmpB) were treated with liposomal AmpB (L-AmpB). AmpB was incorporated into multilamellar vesicles consisting of dimyristoyl phosphatidylcholine and dimyristoyl phosphatidylglycerol in a 7:3 molar ratio. Five patients had underlying hematologic malignancies, one patient had aplastic anemia, and one patient had no underlying disease. All patients had biopsy-proven invasive Aspergillus sinusitis, and had failed conventional antifungal therapy including AmpB. Five patients were cured and two did not respond to treatment. Fever and chills were infrequent and, when they occurred, mild, and responded well to conventional management. No severe renal or central nervous system toxicity was observed. L-AmpB is effective and less toxic than conventional AmpB in the treatment of invasive Aspergillus sinusitis.     

抗VEGF角膜基质注药联合手术治疗假性翼状胬肉1例

目的 分享1例抗VEGF角膜基质注药联合手术治疗假性翼状胬肉的临床疗效。方法 复习1例老年男性患者的病例资料,因左眼被铁水烫伤继发睑球粘连及假性胬肉,行左眼假性胬肉切除+自体角膜缘干细胞结膜瓣移植+口唇黏膜移植+羊膜覆盖+眼睑成型术。在此之前左眼行2次羊膜移植术、睑裂缝合术及3次结膜下+角膜基质内抗VEGF注药术,术后抗感染治疗。结果 术后1个月,左眼视力0.2,移植的唇黏膜及球结膜恢复血供,角膜局限性混浊,前房中深,虹膜无前后粘连,晶状体轻度混浊,眼底(-)。结论 此病例较罕见,热烫伤后继发重度睑球粘连及假性翼状胬肉,治疗难度大。对于肥厚的假性翼状胬肉可先行抗VEGF角膜基质注药,待胬肉变薄后行手术治疗可取得较好的临床疗效。     

Laryngeal cyst- case report

Laryngeal cysts are rare, generally benign lesions which can affect all age groups. We report a case of huge supraglottic cyst. A 19 years old female presented with hoarseness and airway obstruction secondary to large cystic muss involving the entire right side of supraglottis attached to right aryepiglottic fold. Cyst was dissected by laryngofissure approach. On regular follow up for 3 years there is no recurrence of the lesion.     

Tackling the case report

OBJECTIVE: Resuscitative measures are required to ensure the survival of the case report in medical writing. The aim of this study was to assess a series of case reports for quality improvement. METHODS: All articles pertaining to a single patient published in Auris Nasus Larynx and The Journal of Laryngology and Otology from January to December 2000 inclusive were examined. Data recorded included authorship numbers and origin of the report, pertinence of the accompanying abstract, length of the article, claims of a first and the number of references included in the bibliography. RESULTS: Twelve different countries produced 129 papers in the two journals. Author numbers ranged from 2 to 7 (mean 4.56) in Auris Nasus Larynx, and were 1 to 11 (mean 2.63) in The Journal of Laryngology and Otology. Overall, there were 45 articles of two pages or less. An appropriate summary existed in 79.6% of articles published in Auris Nasus Larynx and in 33.9% of abstracts located in The Journal of Laryngology and Otology. A unique occurrence was reported in 14 and 27.82%, respectively. The number of citations ranged from 3 to 28 (mean 12.4) in Auris Nasus Larynx and 2 to 28 (mean 10.2) in The Journal of Laryngology and Otology. CONCLUSION: Case reports require a more applicable summary with a limit on authors, pages and references.     

Sinonasal teratocarcinosarcoma-A case report

Sinonasal teratocarcinosarcoma is a very rare tumor of ambiguous origin. Detailed examination of the biopsy material is essential for diagnosis. It is a very aggressive tumor with a five-year survival rate of 45%. Surgery with radiotherapy has been shown to be effective. We report a case of a 38-year old Indian gentleman with left nasoethmoidal mass eroding the cribriform plate with intracranial extension. Subtotal endoscopic excision of the mass revealed features of a sinonasal teratocarcinosarcoma. Immunohistochemistry confirmed the same. The patient was subsequently treated with radiotherapy. The clinical features, histopathological and immunohistochemistry findings and management of sinonasal teratocarcinosarcoma are discussed.