Preliminary Results of Instantaneous Centre of Rotation Change after Thoracic Instrumentation in Adolescent Idiopathic Scoliosis Patients

Introduction

The instantaneous centre of rotation (ICR) is the centre of motion with zero velocity where a rigid body moves in a particular plane. ICR, as a dynamic measurement, gives more accurate results in terms of quality and quantity of the vertebral motions compared to range of motion (ROM). We aimed to determine the effect of thoracic instrumentation on cervical movement of adolescent idiopathic scoliosis (AIS) patients who had undergone thoracic level instrumentation by measuring pre-operative and post-operative ICR change in a pilot study.

Materials and methods

A total of 25 AIS patients were included in this study. C4-C5 and C6-C7 segmental ICR were determined by pre-operative and post-operative cervical flexion-extension radiographs. In addition, cervical sagittal parameters and global sagittal parameters were investigated.

Results

There was no statistically significant change in ICR location post-operatively in both x and y coordinates at C4-C5 segment (p: 0.326 and p: 0.946, respectively) and C6-C7 segment (p: 0.209, p: 0.086, respectively). There was a positive correlation between LCL and C4-C5 ICR y coordinate (r: 0.481), but not with C6-C7 ICR y coordinate (r: -0.2, p: 0.398). T5-T12 kyphosis decreased (p: 0.002) and T1 pelvic angle (0.003), SVA (0.02) and sacral slope (0.049) increased significantly post-operatively. T1S was correlated with LCL (r: 0.595, p: 0.002), T5-T12 kyphosis (r: 0.423, p: 0.035), SVA (r: 0.658, p<0.001) and C2-C7 SVA (r: 0.416, p: 0.039).

Conclusion

The ICR for cervical region was not changed post-operatively in AIS patients with thoracic instrumentation. There was no relationship found between the development of post-operative cervical kyphosis or lordosis and ICR, which represents the quality and quantity of intervertebral motion. The T1 vertebra plays a key role for cervical, thoracic, and global parameters interaction.

Bilateral microtia, canal atresia and aplasia of cochleovestibular nerve

A six-month-old baby with congenital patent ductus arteriosus (PDA), bilateral microtia and canal atresia was referred for hearing assessment. The audiology assessment revealed bilateral profound hearing loss, which is atypical for a case of pure canal atresia. Imaging was performed much earlier than usual and, as suspected, the patient also had bilateral severe inner ear anomaly. It is extremely rare for a person to have both external and inner ear anomaly because of the different embryological origin. The only suitable hearing rehabilitation option for this kind of patients is brainstem implant. However, the parents had opted for sign language as a form of communication.

Rare embryonal rhabdomyosarcoma of external acoustic canal: a case report and literature review

Embryonal rhabdomyosarcoma of external ear canal is very rare, even in the pediatric population. We report an embryonal rhabdomyosarcoma of external acoustic canal, occurring in a 12-year-old Chinese girl who presented with left ear canal mass. Wide local excision of the mass was done under local anesthesia. Histopathological examination revealed the diagnosis. She then underwent 20 cycles of radiotherapy. CECT scan post treatment showed clearance of tumor cell. Now, patient is disease free for 5 years. We believe that early diagnosis followed by complete resection of the tumor with clear margin and radiotherapy improves the prognosis of the disease.

Vascular loop in the cerebellopontine angle causing pulsatile tinnitus and headache: a case report

Tinnitus is a common disorder, it can be classified as pulsatile and non-pulsatile or objective and subjective. Pulsatile tinnitus is less common than non-pulsatile and can be due to vascular tumour such as glomus or vascular abnormality. We presented an interesting case of a 30 year-old Malay lady with a two-year history of pulsatile tinnitus which was worsening in three months duration. It was associated with intermittent headache. Clinical examination and tuning fork test were unremarkable. Apart from mild hearing loss at high frequency on the left ear, the pure tone audiogram (PTA) was otherwise normal. In view of the patient's young age with no risk factor for high frequency loss, a magnetic resonance imaging (MRI) was performed to look for any abnormality in the cerebellopontine angle. It revealed a single vessel looping around the left vestibulocochlear and facial nerves at the cisternal portion, likely a branch of the anteroinferior cerebellar artery (AICA). Literature review on the pathophysiology and treatment option in this condition is discussed.

Outcome of canal wall down mastoidectomy: experience in sixty three cases

A canal wall down mastoidectomy (CWDM) is an effective technique for eradication of advanced chronic otitis media or cholesteatomas. A retrospective study was conducted at a Malaysian Tertiary Medical Center between June 1996 to December 2003 to evaluate the outcome of Modified Radical Mastoidectomy(MRM), a form of CWDM for patients with chronic active otitis media (OM) with cholesteatoma, chronic mastoiditis or chronic active OM with cholesteatoma and mastoiditis. All new cases of MRM which fulfilled the selection criteria were reviewed. The main outcome measures were the hearing outcome and status of dry ear postoperatively. A total of 84 patients had undergone CWDM. However only 63 patients (26 male, 37 female) were included for analysis. The age of the patients ranged between 5 months to 72 years (mean, 31years). The majority of the patients (86%) were adults and 9 (14%) were children. The ossicular chain was eroded in 91% (57 cases). There were 33 patients (53%) who showed no improvement of Air Bone Gap (ABG) closure while 16 patients (25%) had a post-operative improvement. The presence or absence of stapes suprastructure was found to be the major factor in determining the amount of ABG (Chi squared test, P = 0.025 preoperatively and P = 0.031 postoperatively). A dry ear was achieved in 78% of patients with 3% recurrence rate. In conclusion, the study showed that a proper MRM gave high percentage of dry ear and this procedure did not worsen the hearing.

Familial pattern of large vestibular aqueduct syndrome in a Chinese family

Large Vestibular Aqueduct Syndrome (LVAS) is the most common radiographic malformation in children with early onset of hearing loss. Usually its occurrence is non-familial, however intriguingly a portion of patients with LVAS is found to have evidence of genetic predisposition. We described cases of LVAS in two siblings of a Chinese family. The elder sister first presented with reduced hearing since childhood and her brother has a similar complaint upon further questioning. Their hearing test showed bilateral sensorineural hearing loss (SNHL) and computed tomography (CT) of temporal bone showed enlarged vestibular aqueduct in both patients. We described an approach to diagnosis of LVAS and highlight the importance of hearing assessment in genetic link hearing loss.

Surgical outcome of bone anchored hearing aid (baha) implant surgery: a 10 years experience

Bone anchored hearing aid (Baha) implant is an option for patient with canal atresia, single sided deafness(SSD) and chronically discharging ears despite treatments. This retrospective study was conducted from 2001 to 2011 to evaluate the surgical outcome of Baha implant surgery. Thirty-three patients were identified during this study period. Their age at implantation ranged from 5 to 40 years. Of 33 patients, 29 (87.9 %) patients had bilateral microtia and canal atresia, 3 (9.1 %) patients had unilateral microtia and canal atresia and 1 (3.0 %) patients have SSD following labyrinthitis. One patient (3.2 %) had major complication which is lost of implant due to failure of osseointegration. Soft tissue reactions were seen 7 patients (21.1 %). Of these 7 patients, 4 patients required 3-4 procedures as day care operation for excision of the skin overgrowth surrounding the abutment. Recurrent antibiotic treatment was required in 3 patients (9.7 %). None of our patient had history of intraoperative or peri-operative complication following Baha surgery. The commonest complications are local infection and inflammation at the implant site. None of our patient had history of intraoperative or peri-operative complication following Baha implant surgery.

Management of congenital choanal atresia (CCA) after multiple failures: A Case Report

Nasal obstruction in neonates is a potentially fatal condition because neonates are obligatory nasal breathers. Bilateral choanal atresia is therefore a neonatal emergency. Several approaches for corrections of choanal atresia are available including the helium laser: YAG. A 5-year-old Chinese girl born with bilateral choanal atresia, had birth asphyxia that required intubation. She underwent multiple surgeries for correction of choanal atresia at other hospitals but failed to improve. She was referred to Universiti Kebangsaan Malaysia Medical Center (UKMMC) after presenting with intermittent respiratory distress and cyanosis following an upper respiratory tract infection. A repeat computed tomography (CT) scan done preoperatively showed complete bony stenosis over the left choana and finding was confirmed by examination under general anesthesia. She underwent endoscopic transnasal removal of left bony atretic plate. There was no intra or postoperative complications. During follow up 10 years later, the airway on both sides remains patent.

Hidden foreign body in an unexplained asthma

Foreign body aspiration (FBA) is a common condition with potential to cause significant morbidity and mortality. In children, highest incidence is within the first 3 years of life. Without witnessed aspiration or acute symptoms such as choking, coughing or respiratory distress, it may go unnoticed as clinical presentation and radiological investigations generally have low diagnostic value. Delay in diagnosis increases the risk of developing severe complications. Unexplained recurring or persistent lung pathologies in this age group should raise suspicion of FBA, and early bronchoscopy is warranted for confirmation of diagnosis. We report a case of FBA in a 2-year-old boy whom had been symptomatic for 3 months and was treated as bronchial asthma prior to diagnosis of foreign body in the left bronchus. DOI: http://dx.doi.org/10.3329/bjo.v18i2.12017 Bangladesh J Otorhinolaryngol 2012; 18(2): 200-202

The association between GJB2 mutation and GJB6 gene in non syndromic hearing loss school children

Recently, molecular testing for GJB2 mutations has become the standard of care for the diagnosis of patients with non syndromic hearing impairment of unknown cause. The aims of this study are to determine the association between GJB2 mutation and GJB6 and to report the variation of mutations in deaf students who have heterozygous GJB2. This retrospective study was conducted at Universiti Kebangsaan Malaysia Medical Center (UKMMC). Data was collected from previous files and records from Tissue Engineering and Human Genetic Research Group Laboratory. Approval from Ethical Committee was obtained prior to the study. A total of 138 students have been screened in previous studies in UKMMC for the presence of GJB2 mutations as a cause for hearing loss. Thirty four of the 138 subjects have GJB2 mutations; 2 showed homozygous mutations whereas another 32 were heterozygous for GJB2 gene mutation. Only 31 DNA samples of students presented with sensorineural hearing loss with heterozygous mutation in GJB2 gene were included in this study. The sequencing results obtained were analyzed. The degree of hearing loss of those students with association between GJB2 mutation and GJB6 mutation will be discussed. Five out of 31 subjects (16.2%) have mutations in their GJB6 gene, suggesting a digenic inheritance of GJB2/GJB6 mutation. In total, four novel mutations were identified; E137D (n=1), R32Q (n=1), E101K (n=1) and Y156H (n=1) and one mutation deletion; 366delT (n=1). All students with association GJB2 mutation and GJB6 showed severe to profound hearing loss in both ears. Interestingly this study not detected the large deletion of 342 kb in GJB6 gene suggesting that the mutation is very rare in this region compared to certain parts of the world.

Effects of uvulopalatopharyngoplasty: a seven year review

To review the long term outcome of Uvulopalatopharyngoplasty (UPPP) for obstructive sleep apnoea syndrome in a tertiary referral centre. 38 records were traced where UPPP was done from July 2000 to December 2007. 14 patients were followed up for one to seven years where the Epworth sleepiness scale was scored, long term side effects documented and post operative muller's manoeuvre done. Success of UPPP is defined as a reduction in apnoea hypopnea index (AHI) more than 50%. Sixty percent (60%) were successfully treated with UPPP in the long term. Mean ESS was significantly reduced from 12 +/- 6 to 7 +/- 4. 11 out of 14 patients (78.5%) were reported to develop long term side effects of UPPP, the highest being velopharyngeal insufficiency (42.8%). In conclusion, UPPP is effective in improving symptoms of OSA in the long term. However, in view of its side effects, uvula preserving surgery should be considered as a surgical option.

Stem cell genes are poorly expressed in chondrocytes from microtic cartilage

OBJECTIVES

This study was aimed to see the difference between chondrocytes from normal cartilage compared to chondrocytes from microtic cartilage. Specific attentions were to characterize the growth of chondrocytes in terms of cell morphology, growth profile and RT-PCR analysis.

STUDY DESIGN

Laboratory experiment using auricular chondrocytes.

METHODS

Chondrocytes were isolated from normal and microtic human auricular cartilage after ear reconstructive surgeries carried out at the Universiti Kebangsaan Malaysia Medical Centre. Chondrocytes were cultured in vitro and subcultured until passage 4. Upon confluency, cultured chondrocytes at each passage (P1, P2, P3 and P4) were harvested and subjected to growth profile and gene expression analyses. Comparison was made between the microtic and normal chondrocytes.

RESULTS

For growth profile analysis cell viability did not show significant differences between both samples. There are no significance differences between both samples in terms of its growth rate, except in passage 1 where microtic chondrocytes were significant lower in their growth rate. Population doubling time and total number of cell doubling of all samples also did not show any significant differences. Gene expression is measured using Real Time-Reverse Transcriptase Polymerase Chain Reaction (RT-PCR). There is no significant differences in the expression of collagen type I, collagen type II, collagen type X, aggrecan core protein, elastin and sox9 genes in both samples. There are significant lower in the expression of sox2, nestin, BST-1 and OCT-4 gene in microtic chondrocytes compared to the normal chondrocytes. Stem cells markers are included in this study as stemness in cells may imply a greater proliferative potential and plasticity in vitro.

CONCLUSION

Chondrocytes from microtic samples have the same properties as chondrocytes from normal samples and hold promises to be used as a starting material in the reconstruction of the external ear in future clinical application. The reduction in sox2, nestin, BST-1 and OCT-4 gene expression in microtic samples could be the possible cause of the arrested development of the external ear.

A Single Blinded Randomized Controlled Study of the Effect of Conventional Oral Hypoglycemic Agents Versus Intensive Short-Term Insulin Therapy on Pure Tone Audiometry in Type II Diabetes Mellitus

Neuropathy is frequently a late complication of diabetes mellitus. Auditory neuropathy and microangiopathy of inner ear are the possible causes of hearing loss in diabetics. To study the correlation between glycaemic control and hearing threshold in patients with type 2 diabetes mellitus and to determine the differences of hearing threshold between groups treated with different modality. This single blind randomized controlled study was performed at the Department of Medicine and Department of Otorhinolaryngology, Hospital Universiti Kebangsaan Malaysia (UKM) between 1st May 2003 and 31st September 2004. This study was approved by Research Ethics Committee (code number FF-137). Subjects were randomized into two groups. Group 1 were patients treated with conventional oral hypoglycemic agents. The patients in group 2 were those treated with insulin injection. The subjects were seen 4 weekly for 3 months. Audiometric test were performed in all subjects at each visit. Blood were taken for fasting blood glucose, Hb1Ac, and fructosamine at every visit to determine the glycaemic controls of the subject. They were 11 patients (22 ears) treated with oral hypoglycemic agents and 17 patients treated (34 ears) with subcutaneous insulin. There is no significant difference between mean pure tone threshold before and after treatment at all frequencies in both groups. There is also no significance different in fasting glucose level and fructosamine. However, there is significant difference HbA1c levels between the two groups after treatment (P < 0.05). This study has shown that glycaemic control does not have significant impact on hearing. The hearing threshold is neither affected by insulin treatment nor by the glycaemic control.

Congenital cholesteatoma: delayed diagnosis and its consequences

This is a retrospective review of congenital cholesteatoma cases that were managed surgically. There were 5 cases. The age of presentation ranged from 5 to 18 year old. Three patients presented with complication of the disease. Three patients had intact tympanic membrane, two had perforation at the anterior superior quadrant. All patients had cholesteatoma medial to tympanic membrane. Four cases had extensive ossicular erosion with preoperative hearing worse than 40 dB. Four cases underwent canal wall down mastoid surgery and one underwent canal wall up surgery. One patient had recurrence which required revision surgery. In conclusion, congenital cholesteatoma presented late due to the silent nature of disease in its early stage. Extensive disease, ossicular destruction with risk of complication at presentation were marked in our study. Hence, more aggressive surgical intervention is recommended in the management of congenital cholesteatoma.

Temporal bone carcinoma: a case report

Temporal bone carcinoma may masquerade as an infective process causing late diagnosis. A delay in treatment as a result of missed diagnosis would carry a poor prognosis as the disease progresses to an advanced stage. We present a lady with history of chronic otorrhea, who developed left sided otalgia associated with hearing loss in her sixth decade. She underwent surgery which revealed left mastoiditis and cholesteatoma. After a year, she had a mass in her left ear and pus discharge which was initially treated as an infection. The biopsy of the mass was proven to be squamous cell carcinoma. High index of suspicion is necessary when encountering patients presenting with a mass in the ear canal with prior history of chronic otorrhea or cholesteatoma. Proper tissue biopsy is crucial. Early referral to tertiary centre is required for further management of the patient.

Otosclerosis and the role of second ear surgery

Hearing loss and tinnitus are the main symptoms of otosclerosis. Little is known about the cause of tinnitus in otosclerosis and the factors influencing the effect of surgery on tinnitus. Though by surgery, we are able to inform patient about probable hearing gain and even benefit concerning bilateral hearing, it is however difficult to predict the course of tinnitus. The principle aim of stapes surgery is to restore hearing but some patients also report reduction in the severity of tinnitus and even complete cessation of it. We describe a case report of a 37 year old male who underwent a second stapes surgery. We wish to illustrate that for our patient, tinnitus represents a major disturbance and the patient is as much concerned with the improvement of hearing as with the improvement of tinnitus.

Therapeutic approach in managing patients with large vestibular aqueduct syndrome (LVAS)

OBJECTIVE

To discuss the clinical approach in managing patients with large vestibular aqueduct syndrome.

METHODS

Over the period from November 1997 to March 2005, 106 children have been fitted with cochlear implants in Antwerp University Hospital (UZA). The Hospital University of Maastricht (azM) had implanted 36 children since 1999 to March 2005. The present study focuses on nine children and one adult patient with large vestibular aqueduct syndrome (LVAS). The medical, report and radiology report were retrospectively analysed.

RESULTS

Eight out of nine children with LVAS had been implanted and one child was on the waiting list. One adult patient was implanted with Nucleus 24M at the age of 22 years old. Nine out of 10 patients had bilateral large vestibular aqueduct. There were no intraoperative or postoperative complications encountered.

CONCLUSION

Cochlear implantation is a safe operation for patients with LVAS.

Comparison of Food Choice Motives between Malay Husbands and Wives in an Urban Community

The main objective of this study was to determine the motives underlying the selection of foods between husbands and wives in an urban community. Thiscross-sectional study was carried out in Bandar Baru Bangi, Selangor, Malaysia among 150 married couples aged 20 and above, who voluntarily agreed to participate and were not on any special diet. Data were collected using the Food Choice Questionnaire (FCQ) which measured the health-related and non health related factor that influence people's food choices. It consisted of 36 items designed to assess the reported importance of nine factors: health, mood, convenience, sensory appeal, natural content, price, weight control, familiarity, and ethical concern. In this study, the FCQ was adapted and a new factor, religion (religious guidelines), was included. Demographic characteristics including age, occupation, education, household income and household size were also collected. Data were analysed using SPSS version 16. Results showed that 40.7% of husbands (mean age= 43.33 + 11.16 years) and 55.3% of wives (mean age= 41.28 + 10.93 years) perceived themselves as the main food shopper while 12.0% of the husbands and 85.3% of the wives perceived themselves as the main meal planner. Husbands rated religion as the most prominent factor in food choice motives with a mean average rating of 4.56 + 0.59 on a 5-point rating scale, followed by health and convenience factor. Meanwhile, the wives rated health as the most essential factor with mean average rating of 4.49 + 0.58, followed by religion and convenience factor. Sensory appeal, ethical concerns and familiarity were rated as the bottom three factors of food choice motives among these two groups. Price of foods was not considered as an important factor in making food choices for the subjects in this study. In conclusion, the husbands and wives of this urban community rated religion, health and convenience as the three most important food choice motives in food selection.

Iatrogenic facial nerve palsy: lessons to learn

INTRODUCTION

This study aims to review the management and discuss the outcome of patients with iatrogenic facial nerve palsy.

METHODS

11 patients with iatrogenic facial nerve palsy (FNP) were evaluated retrospectively in a tertiary centre between June 1995 and September 2008. All the cases were referred from other centres.

RESULTS

Ten patients had iatrogenic immediate FNP secondary to mastoidectomy and one had FNP secondary to superficial parotidectomy. Of the ten cases, three had concomitant profound sensorineural hearing loss and one had concomitant labyrinthine fistula. Ten patients underwent facial nerve exploration and one patient was managed conservatively. The second genu was the commonest site of injury (60 percent). Facial nerve recoveries were achieved to Grade I House Brackmann classification in five cases, Grade II in two cases and Grade III in two cases postoperatively. One case defaulted follow-up. One patient, managed conservatively, recovered to FNP Grade II after five months post-injury.

CONCLUSION

Mistakes that most likely occurred during mastoid surgery are drilling towards the antrum, causing injury to the facial nerve at the second genu. Early facial nerve exploration and neurolysis resulted in good facial nerve recovery.

Benefit and pitfalls of newborn hearing screening

The importance of universal newborn hearing screening (UNHS) in identifying hearing-impaired infants as early as possible is already well recognized. Transient evoked otoacoustic emissions (TEOAE) have been established as a reliable method for UNHS in full term infants. This is a cross sectional study between April 2003--December 2005. Thirteen thousand five hundred and ninety eight (13,598) newborns were screened for hearing loss with portable otoacoustic emission (OAE) before discharge. The initial coverage rate during the 3 years study period was 85.9% (13,598) with 89.2% (3762), 79.0% (4480) and 90.3% (5356) for 2003, 2004 and 2005 respectively. The mean age when hearing loss was diagnosed using ABR were 3.56 months old, 3.08 months old, and 2.25 months old and 3.01 months old for 2003, 2004, 2005 respectively and it was statistically significant. The defaulter rate at the third stage during the 3 years study period was 35% (21), 15.2% (7) and 18.2% (2) for 2003, 2004 and 2005 respectively. This study showed significant improvement in initial referral rate, coverage rate and age of diagnosis. However, we need to improve on high defaulter rates.

Growth kinetic study on normal and microtic chondrocytes of human auricular cartilage

Chondrocytes were isolated from normal and microtic human auricular cartilage after ear surgery carried out at Universiti Kebangsaan Malaysia Medical Centre. Chondrocytes were cultured and expanded until passage 4. After reached confluence, cultured chondrocytes at each passage (P1, P2, P3 and P4) were harvested and assigned for growth profile analysis. There was no significant difference in cell viability between both normal and microtic samples (p = 0.84). Both samples showed no significant differences for growth profile parameters in terms of growth rate, population doubling time and total number of cell doubling, except in passage 1, where there is significant difference in cell growth rate (p = 0.004). This preliminary data has indicated that chondrocytes from microtic cartilage has the potential to be used in the reconstruction of human pinna in the future.

Detection of sensorineural hearing loss using automated auditory brainstem-evoked response and transient-evoked otoacoustic emission in term neonates with severe hyperbilirubinaemia

INTRODUCTION

This study was designed to compare the sensitivity and specificity of detecting sensorineural hearing loss (SNHL) using the transient-evoked otoacoustic emissions (OAE) machine (the Madsen TE Echoscreen) and automated auditory brainstem response (AABR) machine (the Sabre Compac portable AABR) in term neonates exposed to severe hyperbilirubinaemia.

METHODS

This was a prospective study carried out over a 30-month period in a neonatal intensive care unit. Term infants (gestation equal to or greater than 37 weeks) with severe hyperbilirubinaemia (peak total serum bilirubin level equal to or greater than 300 umol/L) were recruited. Hearing tests were carried out before discharge.

RESULTS

The median age of the 250 study infants when OAE and AABR were tested, was eight days (IQR four days) and their median age when auditory brainstem-evoked response (ABR) was done was 58 days (IQR 56 days). Based on the findings of ABR, 32 (12.8 percent) infants had unilateral or bilateral SNHL. There was no significant difference in the peak total serum bilirubin levels between infants with SNHL (median 333 umol/L, IQR 57) and those without (median 340 umol/L, IQR: 58) (p-value is 0.3). The sensitivity of OAE for detecting SNHL was 15.9 percent, and its specificity 95.2 percent. The sensitivity of the Sabre Compac portable AABR machine for detecting SNHL was 40.9 percent and its specificity was 63.2 percent.

CONCLUSION

Both the OAE machine and the Sabre AABR machine were not sensitive enough for mass screening of SNHL in infants exposed to severe hyperbilirubinaemia.

Pediatric auricular chondrocytes gene expression analysis in monolayer culture and engineered elastic cartilage

OBJECTIVES

This study was aimed at regenerating autologous elastic cartilage for future use in pediatric ear reconstruction surgery. Specific attentions were to characterize pediatric auricular chondrocyte growth in a combination culture medium and to assess the possibility of elastic cartilage regeneration using human fibrin.

STUDY DESIGN

Laboratory experiment using human pediatric auricular chondrocytes.

METHODS

Pediatric auricular chondrocytes growth kinetics and quantitative gene expression profile in three different types of media were compared in primary culture and subsequent three passages. Large-scale culture-expanded chondrocytes from the combination medium were then mixed with human fibrin for the formation of elastic cartilage via tissue engineering technique.

RESULTS

The equal mixture of Ham's F12 and Dulbecco's Modified Eagle Medium (FD) promoted the best chondrocyte growth at every passage compared to the individual media. Chondrocytes differentiation index; ratio of type II to type I collagen gene expression level, aggrecan and elastin expression gradually decreased while passaging but they were then restored in engineered tissues after implantation. The engineered cartilage was glistening white in color and firm in consistency. Histological evaluation, immunohistochemistry analysis and quantitative gene expression assessment demonstrated that the engineered cartilage resemble the features of native elastic cartilage.

CONCLUSION

Pediatric auricular chondrocytes proliferate better in the combination medium (FD) and the utilization of human fibrin as a biomaterial hold promises for the regeneration of an autologous elastic cartilage for future application in ear reconstructive surgery.

Massive epistaxis secondary to pseudoaneurysm of internal carotid artery

Post-traumatic pseudoaneurysms of internal carotid arteries are uncommon. The patients may present with massive epistaxis due to rupture of the aneurysm into the sphenoid sinus. Early diagnosis and treatment is mandatory as the likelihood of exsanguinations increases with each subsequent episode of epistaxis. The clinical features of unilateral blindness and massive epistaxis after head injury should indicate the diagnosis. The high mortality of this entity underlines the importance of early angiography in these patients to confirm this diagnosis. We present 3 cases of post-traumatic aneurysm of the ICA.

Kimura's disease: an unusual cause of cervical tumor

Kimura's disease (KD) is an angiolymphoid proliferative disease of soft tissue with peripheral blood eosinophilia and elevated serum immunoglobulin (Ig) E. The treatment options range from conservative observation for the asymptomatic patient to surgical excision, steroid therapy and radiotherapy for symptomatic patients. Surgical excision is the most common diagnostic measure and is the treatment of choice. A case of KD in a 13-year-old Malay girl is presented. Clinically there was painless right jugular digastric mass measuring 3cm by 3cm. Her blood investigation showed pronounced eosinophilia. She underwent excision biopsy uneventfully. The biopsy from the swelling showed reactive follicular hyperplasic with prominent eosinophilia. There was no evidence of malignant change. Postoperatively after 3 years follow up, she was asymptomatic and no signs of tumor recurrence.

Production of safe therapeutic feeds from contaminated water supplies

We have assessed the effectiveness of using an osmotic sachet for safe rehydration of therapeutic milk from contaminated water supplies in a poor urban area of Bangladesh. 35 women were given sachets to hydrate in their homes and comparison of the hydration water and the reconstituted milk showed that the high bacterial contamination reported in the domestic water supply was removed by use of the sachet. The mean rehydration time was 4.5 h (range 3.4-5.5). This rehydration method could have a role in the preparation of therapeutic feeds where microbiological contamination of the environment is a serious problem and availability of adequate water is not a limiting factor.