Unsuspected breast carcinoma presenting as orbital complication of rhinosinusitis

We report a rare clinical presentation of breast carcinoma metastasis to the ethmoid sinuses, orbit and cavernous sinus in a 70-year-old lady with unsuspected breast carcinoma who presented with clinical features of acute ethmoiditis, orbital cellulitis and cavernous sinus thrombosis. The patient underwent endoscopic ethmoidectomy and histology of the necrotic tissue from the ethmoidal cells was positive for endovascular neoplastic emboli. Subsequent examination revealed a large mass in the left breast, tethered to the skin, which was histologically confirmed to be a carcinoma. The patient died 2 months post-diagnosis. To our knowledge, this is the third case manifesting with combined features of ethmoiditis, orbital cellulitis and cavernous sinus syndrome from an unsuspected breast carcinoma. This case highlights the importance of imaging and thorough physical examination when a dramatic clinical picture presents in the paranasal sinuses of an otherwise healthy individual. Such manifestation of breast carcinoma is difficult to diagnose, and therefore, a high index of suspicion should be maintained. Skull base metastases from breast carcinoma behave aggressively and if diagnosed early, treatment may prolong survival and improve quality of life.     

Nasal fiberoptic intubation with and without split nasopharyngeal airway: Time to view the larynx & intubate

Background

Fiberoptic intubation requires long nasopharyngeal journey and mostly requiring jaw thrust to visualize larynx especially if done under general anesthesia. Use of split nasopharyngeal airway of appropriate length for better glottis visualization has been compared with the classic one.

Impedance and Dielectric Properties of PVC:NH4I Solid Polymer Electrolytes (SPEs): Steps toward the Fabrication of SPEs with High Resistivity

In the present article, a simple technique is provided for the fabrication of a polymer electrolyte system composed of polyvinyl chloride (PVC) and doped with varying content of ammonium iodide (NH₄I) salt using solution-casting methodology. The influences of NH₄I on the structural, electrochemical, and electrical properties of PVC have been investigated using X-ray diffraction, electrochemical impedance spectroscopy (EIS), and dielectric properties. The X-ray study reveals the amorphous nature of the polymer–salt complex. The EIS measurement revealed an ionic conductivity of 5.57 × 10⁻¹⁰ S/cm for the electrolyte containing 10 wt.% of salt. Our hypothesis is provided, which demonstrated the likelihood of designing highly resistive solid electrolytes using the concept of a polymer electrolyte. Here, the results showed that the resistivity of the studied samples is not dramatically decreased with increasing NH₄I. Bode plots distinguish the decrease in resistance or impedance with increasing salt contents. Dielectric measurements revealed a decrease in the dielectric constant with the increase of NH₄I content in the PVC polymer. The relaxation time and dielectric properties of the electrolytes confirmed their non-Debye type behavior. This pattern has been validated by the existence of an incomplete semicircle in the Argand plot. Insulation materials with low ε_r have found widespread applications in electronic devices due to the reduction in delay, power dissipation, and crosstalk. In addition, an investigation of real and imaginary parts of electric modulus leads to the minimized electrode polarization being reached.     

Thyroglossal duct cyst excision with hyoid bone preservation

The objective of this study is to assess complete removal of the thyroglossal duct cyst (TGDC) and its tract(s) to the base of the tongue with sparing of the hyoid bone. This is a prospective cohort study. Tertiary hospital (Zagazig university hospital). This prospective study was carried out on 21 patients who had been diagnosed preoperatively as TGDC or fistula. All patients were managed by dissection and removal of the TGDC and its tract(s) to the base of the tongue with sparing of the hyoid bone. The study was conducted on 12 males (57.14 %) and 9 females (42.85 %) with mean age 6.8 years (4–20 years). After histopathological examination; 16 patients (9 male and 7 female) were proved to have TGDC and 5 patients (3 male and 2 female) were proved to have dermoid cyst. The hyoid bone could be preserved in all cases except in two cases for whom the middle third of the hyoid bone was removed with the specimen. Multiple tracts were found in three cases and could be identified and dissected successfully with sparing of the hyoid bone. Identification, dissection, and complete excision of the TGDC with its attaching tract(s) could be performed without hyoid bone resection with no recurrence and minimal minor complication. The impacts of this hyoid bone preservation versus removal on the pattern of swallowing and retroglossal space need to be studied.     

Can the source of hyperandrogenism in adolescents with polycystic ovary syndrome predict metabolic phenotype?

In this study, we demonstrated an association between adrenal hyperandrogenism, as determined by dehydroepiandrostenedione-to-free testosterone (DHEA-S/FT) ratio, and metabolic phenotype in obese and lean adolescents with polycystic ovary syndrome (PCOS). We compared 64 overweight/obese adolescents with PCOS (PCOS-O) with 18 lean (PCOS-L) adolescents. We analyzed the association between DHEA-S/FT ratios and metabolic parameters. Patients in the PCOS-O group were younger (median [interquartile range]) than those in the PCOS-L group (15 [15-17] vs. 16 [16–17] years; p?=?.04). The median DHEA-S/FT ratio and total testosterone concentrations did not differ. However, androstenedione concentrations were higher in the PCOS-L group (p?=?.02) and free testosterone levels lower in the PCOS-L group compared with the PCOS-O group (p?=?.02). Insulin resistance was present in 30 of 64 (46.9%) adolescents with PCOS-O compared with 1 of 18 (5.6%) with PCOS-L (p?=?.001). A significant negative correlation between DHEA-S/FT ratios and insulin concentrations in PCOS-O (p?=?.03) and PCOS-L (p?=?.04) groups was noted. In the PCOS-O group, the DHEA-S/FT ratio was negatively associated with serum triglyceride (p?=?.03) and total cholesterol concentrations (p?=?.02). We conclude that in adolescents with PCOS, a higher ratio of adrenal to ovarian androgens, signified by DHEA-S/FT, may be associated with a more favorable metabolic phenotype.     

The association of the blastomere volume index (BVI), the blastomere symmetry index (BSI) and the mean ovality (MO) with ongoing implantation after single embryo transfer

Purpose

To generate novel, objective variables that resemble embryo quality and relate them to ongoing implantation, using multilevel imaging of single-transferred embryos.

Methods

Retrospective analysis of multilevel images of 659 day 3 single-transferred embryos. Each embryo was photographed on seven different levels, in order to measure the largest diameter of every blastomere within an embryo. The volume of each blastomere was calculated using the equation $ 1/6\pi ^*\mathrm{diamete}{{\mathrm{r}}^3} $ . The blastomere volume index (BVI) represented the ratio between the total blastomeric volume of an embryo and the mean cytoplasmic volume of an oocyte on day 0. The blastomere symmetry index (BSI) represented the ratio between the greatest blastomere volume and the smallest blastomere volume within an embryo. The mean ovality (MO) represented the presence of non-spherical blastomeres. Analyses were performed to compare the BVI, BSI and MO between patients with and without an ongoing implantation.

Results

The mean BVI was significantly higher for embryos in the ongoing implantation group compared to the no ongoing implantation group. The mean BSI was associated with ongoing implantation for unevenly cleaved embryos. The MO of blastomeres within an embryo was similar for embryos in the ongoing implantation group compared to the no ongoing implantation group. The association of the BVI and BSI with ongoing implantation was confounded, because only female age and cleavage rate were significantly associated with ongoing implantation in multiple logistic regression analyses.

Conclusions

The BVI, BSI and MO are objective variables that resemble embryo quality, but they are not suitable to use as embryo selection tools.