Prevention and management of synechia in pediatric endoscopic sinus surgery using dental wax plates

Synechia formation is a very common complication of endoscopic sinus surgery (ESS). Inspite of meticulous post-operative care, synechia do form in quite a large number of patients. Moreover, frequent post-operative cleaning may not be possible without general anesthesia in non-compliant patients, especially children. This study compares the incidence of synechia following pediatric ESS with or without spacer/tamponade in the operated cavity. The authors have found dental wax plates to be equally effective and more economical spacers compared to Merocel tamponade, in prevention and management of synechia in the pediatric age group.     

Solitary adult myofibroma of the pinna.

Solitary myofibroma is a recently described benign neoplasm of the skin or superficial soft tissue and it represents the adult counterpart of infantile myofibromatosis. This new clinicopathological entity is being recognized increasingly. A case of solitary myofibroma occurring in the pinna of a 50-year-old woman is presented. Such a lesion occurring in the pinna of an adult has not been reported in the literature.     

RANTES levels as a determinant of falciparum malaria severity or recovery

The study explored the role of differential RANTES concentrations, its receptor CCR5 expression and resulting immunomodulation in the pathogenesis and/or recovery from falciparum malaria. The study population included cases of uncomplicated malaria (UC‐M, N=128, enrolled on follow‐up basis), severe malaria (SM, N=25), and healthy controls (N=112). Serum RANTES and TNF‐α levels were evaluated by ELISA. Monocyte levels and activation profile were studied by flow cytometry. Differential mRNA expression profile was studied by real‐time PCR. Blood parasite count was evaluated by registered pathologists. RANTES concentration was significantly downregulated in SM cases compared to UC‐M (P=.046) and controls (P<.001). Expression of monocyte marker mCD14, activation markers CCR5 and CD40, and downstream effector cytokine TNF‐α was significantly higher in malaria cases compared to controls, in SM cases compared to UC‐M. TNF‐α expression correlated positively with CD40 and CCR5 expressions. Follow‐up‐based analysis showed that RANTES concentrations increased on recovery compared to baseline in UC‐M cases (P=.106) and inversely correlated with malaria parasite load, mCD14, CCR5 and CD40, and TNF‐α expressions. These findings suggest an important association of RANTES concentrations in Plasmodium falciparum malaria disease pathogenesis, as well as recovery, mediated through differential modulation and regulated activation of monocytes and cytokine TNF‐α.     

Hepatocellular carcinoma presenting as an isolated sphenoid sinus lesion: a case report

We report a rare case of a metastatic sphenoid sinus lesion originating from an undiagnosed hepatocellular carcinoma (HCC) in a 53-year-old man who presented with gradually progressive external ophthalmoplegia. Imaging showed a right sphenoid sinus lesion infiltrating the parasellar region. Although a primary sphenoid biopsy was inconclusive, positive hepatitis B surface antigen and CT-guided fine-needle aspiration cytology suggested an HCC. A repeat endoscopic biopsy from the sphenoid with immunohistochemistry confirmed the lesion to be metastatic HCC. Metastasis to the paranasal sinuses is extremely rare, and metastasis from a liver primary even more rare. Because of clinical and radiologic similarity between the primary and metastatic lesions, metastasis to the sphenoid sinus is often undiagnosed. Patients with features suggestive of sphenoid sinus malignancy should also be evaluated for the possibility of a metastatic tumor. In this article, we emphasize the rarity of the tumor, the unusual presenting symptoms, and problems with early diagnosis.