Anatomical variations of nose and para-nasal sinuses; CT scan review

Objective: To determine the frequency of anatomic variations on computed tomography scan of para-nasal sinuses.Methods: The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised computed tomography scans of 77 patients who had presented between October 2007 and March 2011. All the scans were reviewed using Picture Archiving Communication System computer software. The scans were reviewed for the presence of deviated nasal septum, paradoxical middle turbinate, Haller cell, Onodi cell, and pneumatisation of the middle turbinate and uncinate process.Results: The mean age of the patients was 31±13.15 years. One or more types of anatomical variants were observed in 40 (51.9%) of the patients; the most frequent being the deviated nasal septum 20 (26%) and the Concha bullosa 14 (18.2%).Conclusion: Considering the wide range of variations in the anatomy, each and every para-nasal sinus case should be planned individually and carefully to avoid dreadful complications and maximise patients’ benefit

Post-traumatic pseudoaneurysm of internal carotid artery: a cause of intractable epistaxis.

In this case report, the authors are presenting a case of a 35-year-old lady who presented to our clinic with recurrent episodes of massive epistaxis and loss of right eye vision for last 6 months following road traffic accident. There was no other significant medical and surgical history. Bleeding episodes were sometimes very severe with loss up to 400-500 cc and would stop spontaneously. She was given multiple blood transfusions after these episodes. A complete otorhinolaryngological examination including rigid endoscopy and coagulation investigation did not reveal any abnormality. CT with contrast of paranasal region showed blood within the right sphenoid sinus with linear fracture of the lateral wall with post-traumatic cavernous pseudoaneurysm of internal carotid artery localised to right sphenoid sinus. That was managed successfully by embolisation using a detachable balloon and a coil. She was followed up in the clinic at 6 weeks and 6 months interval with no symptoms

An unusual case of cauda equina secondary to spinal metastasis of thyroid cancer

Abstract INTRODUCTION: Cauda equina secondary to metastatic follicular thyroid cancer of the lumbosacral area is a rare entity. CASE REPORT: We report an unusual case of a 52-year-old male who presented with backache, lower limb weakness, and perianal numbness. A CT-scan of the lumbosacral area showed an enhancing mass at the L4, L5 and S1 vertebrae. Histopathology after excision revealed a metastatic thyroid cancer. Hence, a CT scan of the neck and chest was performed which showed a nodule in the left lobe of the thyroid and a mass in the left chest wall. A total thyroidectomy and excision of the chest wall lesion was undergone, which was diagnosed as a follicular carcinoma of the thyroid. CONCLUSION: Metastatic workup of spinal metastasis should include evaluation of the thyroid gland

The impact of socially responsible investments on sinful firms: An empirical analysis of the UN Principles of Responsible Investment and sin stocks

We study the effects of the United Nations Principles of Responsible Investment (UN-PRI) on sinful firms, in which we examine whether monthly returns and the Environmental, Social and Corporate Governance (ESG) performance have changed due to an increase in socially concerned investors. We find evidence suggesting that increased commitment to Socially Responsible Investments (SRI) has a negative effect on sinful firms, estimated to reduce monthly returns by 0.040 percent. This corresponds to a 4.4 percent decrease in the average monthly return. Our findings for ESG performance indicate that the ESG score is unaffected by the additional commitment to the UN-PRI. We conduct the analysis on geographical location and industrial affiliation to determine if these effects are uniform across all samples. Our results suggest that regions and industries have differentiating results.nhhma

A case of otogenic tetanus.

The authors are presenting our experience of managing an interesting case of a 12-year-old girl who presented to our clinic with otorrhea for 3 months and trismus for 1 week. Examination showed bilateral ear discharge with central perforations in tympanic membranes, palatal paralysis and trismus. Systemic examination revealed only mild stiffness of hand muscles. CT-scan head and neck was done to look for intracranial complications of otitis media. However, it revealed only decreased pneumatisation of mastoid cells. She was admitted in the hospital and started on intravenous and local antibiotics after sending ear swab and blood cultures. But she showed no improvement in 48 h. So on the clinical suspicion (trismus and stiffness of hands) remote possibility of otogenic tetanus was considered and she was given tetanus toxoid and immunoglobulins. She gradually showed improvement in her symptoms. Thereafter, culture from ear discharge was also reported positive for Clostridium tetani

Readmissions after day care surgery In ent : A tertiary care experience

BACKGROUND: Re-admission following day care surgery in ENT (Ear, Nose & Throat) results in significant morbidity to patient & massive load to hospital & also raises the question on the safety of day care surgery. Only a small number of published studies emphases on return to hospital within 30 days following day care surgery in otorhinolaryngology especially from our region. This study was carried out to determine the frequency of re-admission after day care surgery in ENT. METHODS: We prospectively studied consecutive patients who underwent ENT procedures [i.e., septoplasty, tympanoplasty type I & functional endoscopic sinus surgery (FESS) for deviated nasal septum (DNS), chronic suppurative otitis media tubotympanic (CSOM TT) variety & ethmoidal nasal polyposis (ENP) respectively] as day care surgery case under general anaesthesia at the Section of Otorhinolaryngology and Head & Neck Surgery, Aga Khan University Hospital & Liaquat National Hospital, Karachi from January 2015 to December 2016. All patients aged 20- 60 years of both genders were included in the study. SPSS software version 20 was used for data compilation and analysis. p-value less than or equal to 0.05 was taken as significant. RESULTS: In the phase of 24 months, total 317 cases met the inclusion criteria & were included in the study. There were 205 males & 112 females in the study population. One hundred & twenty-two patients having DNS, 128 having CSOM TT & 67 suffering from ENP & underwent septoplasty, tympanoplasty type I & FESS respectively. Complications were observed in a total of 7 (2.2%) patients in our study group & required re-admission within 1 month of surgery. Stratification was done between re-admission & all effect modifiers, with all showing insignificant results. CONCLUSIONS: Our results demonstrate that ENT surgeries (septoplasty, tympanoplasty type I & FESS) are safe procedures which can be performed as a day care case with acceptably low readmission rates