Ingested fish bone: an unusual presentation.
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Adult↗
Biomedical subjects
D S Sethi
Publications and source records attributed to D S Sethi.
Immunologic defects in patients with chronic recurrent sinusitis: diagnosis and management.
Twenty patients with chronic refractory sinusitis or rhinitis were identified to have immune defects on the basis of total immunoglobulin level, immunoglobulin G subclass, and vaccine response. Eight patients were immunoglobulin A deficient, five had low immunoglobulin levels with vaccine hyporesponse, and four had low immunoglobulin levels with normal vaccine responses. Three subjects showed isolated immunoglobulin G1 deficiency. Demographic variables such as age, sex, infection pattern, and any other related disorders were studied retrospectively, which may have contributed to the diagnosis. An immunologic screen was essential for the diagnosis of immunodeficiency in these patients. Treatment options included prophylactic antibiotics, management of associated allergies, functional endoscopic sinus surgery, and replacement therapy with immunoglobulin in selected patients.
Adolescent↗
Endoscopic anatomy of the sphenoid sinus and sella turcica.
An endoscopic study of the sphenoid sinus was carried out, on 30 cadavers, to understand the important anatomical relationships of the sphenoid sinus, and the sella turcica. The aim was to study the endoscopic anatomy and the variants, and to determine if endoscopic instrumentation and techniques, could play a beneficial role in endoscopic management of sellar lesions. The results of this study are discussed, with particular reference to the important surgical anatomical features of the sphenoid sinus. A surgical technique for the endoscopic transsphenoid approach to the sella turcica was developed. Anatomical variants can be identified endoscopically, and endoscopic techniques have the advantages of improved visualization, magnification, angled vision, and a panoramic perspective of the intrasphenoid anatomy, compared to currently employed methods of pituitary/sellar surgery, using the operating microscope.
Adult↗
Endoscopic management of lesions of the sella turcica.
The excellent visualization and minimally invasive surgical technique of endoscopic sinus surgery was applied to the management of 40 patients with sellar lesions. Endoscopic management of sellar lesions offers, not only the advantage of improved visualization, but also magnification, and a panoramic perspective of the important relationships of the sella turcica. In the past year, we have managed 40 subjects with sellar lesions, endoscopically: 38 patients had pituitary adenomas and two a craniopharyngioma. At our hospital, the endoscope has replaced the operating microscope for surgery for pituitary adenomas and other sellar lesions. The endoscopic approach to the sphenoid sinus and the sella is performed by an ENT surgeon and the ablative surgery performed by a neurosurgeon. Our experiences, using the endoscope to perform surgery on sellar and parasellar lesions, are reported and the advantages, over the operating microscope, which is traditionally used are discussed. The technique for endoscopic management of sellar lesions is described.
Adenoma↗
View from beneath: pathology in focus. Synovial sarcoma of hypopharynx.
Synovial sarcoma of the hypopharynx is a rare neoplasm. To date only 23 cases of synovial sarcoma of the hypopharynx have been reported in the literature. An additional case in an 18-year-old male is presented. This is the first case of synovial sarcoma in the hypopharynx to be reported in Singapore. The presentation was that of a mass in the hypopharynx; progressive dysphagia, intermittent hoarseness and gradual airway compromise. A CT scan was valuable in determining the site of origin and extent of the lesion. Histopathology was diagnostic. Treatment comprised of wide surgical excision of the tumour and post-operative radiotherapy.
Adolescent↗
Migrating foreign bodies in the upper digestive tract.
Migrating foreign bodies in the aerodigestive tract are not so uncommon. Two cases of penetrating and migrating extraluminal foreign bodies in the upper aerodigestive tract are presented. Both patients had ingested fish bones. Fish bones are the commonest of bones to be ingested. Sharp and pointed fish bones are more likely to penetrate extraluminally. A high index of suspicion is necessary to institute early treatment. A CAT scan is invaluable in locating the foreign body especially with regards to surgical landmarks at exploration. Early surgical intervention avoids life-threatening complications.
Adult↗
Parapharyngeal abscesses.
Fifty-five patients with deep neck infections treated consecutively over a period of six and a half years between January 1983 and July 1989 were reviewed. Nine of these patients had abscesses localized to the pharapharyngeal space and form the basis of this study. The aetiology of the parapharyngeal abscess was odontogenic in two patients and remained unknown in the other seven. Five patients had associated systemic disease; four were diabetics and one patient had non-Hodgkin's Lymphoma. High dosage intravenous antibiotics directed towards the causative micro-organisms, airway control and early surgical intervention was the mainstay of treatment. All patients underwent open surgical drainage of the parapharyngeal abscess within 24 h of admission. Bacteriology results showed Klebsiella sp. to be the dominant micro-organism cultured in four patients. Morbidity was low; seven patients had no post-operative complications and were discharged from the hospital between 7-24 d (mean 12.9 d). There were two deaths. Early open surgical drainage remains the most appropriate method of treating parapharyngeal space infections; it avoids life threatening complications with rapid recovery.
Abscess↗
Retropharyngeal abscess--the foreign body connection.
Retropharyngeal abscesses have been described to be more common among children especially under the age of three or four years and oropharyngeal infection have been implicated as a common etiological factor. However, this series reveals that retropharyngeal abscesses are more commonly seen in adults in our local population. Regional trauma resulting from an ingested foreign body is the leading cause of retropharyngeal abscess in this series. Twenty-three patients seen consecutively between January 1983 and June 1989 at the Department of Otolaryngology, Singapore General Hospital were reviewed retrospectively. Factors such as age, sex, racial distribution, presenting symptoms and signs, methods used to arrive at diagnosis, therapy and complications were studied and analysed. A lateral radiograph of the neck was the single most valuable investigation in the evaluation of the retropharyngeal space. Retropharyngeal and retrotracheal width were measured in 210 normal lateral neck radiographs to establish a normal range in our population. Retropharyngeal widening greater than 5 mm and retrotracheal widening greater than 15 mm was considered significant and was noted in all 23 patients. Regional trauma resulting from an ingested foreign body was the cause of the retropharyngeal abscess in thirteen (56.5%) patients.
Abscess↗
Bronchodilator effect of terbutaline aerosol in asthmatic: comparison of two spacer devices.
The degree of bronchodilation achieved with aerosolised bronchodilators may partly depend on correct usage of a particular inhaler device. The effect of two puffs of 0.25 mg each of terbutaline aerosol using either of two spacer devices--a tube spacer and conical spacer with inhalation valve (Nebuhaler)--in a randomised manner were compared in 20 patients with bronchial asthma. All participants (11 male, 9 female) aged 16 to 50 years had clinically stable baseline airway obstruction responsive to bronchodilators. The maximum per cent increase of PEFR and FEV1 were significantly higher after inhalation via Nebuhaler than tube spacer (44.93 +/- 21.15% vs 26.67 +/- 13.17%; 74.0 +/- 17.87 vs 47.65 +/- 15.74% respectively, p less than 0.01). The increase noted at each time interval was significantly higher and more sustained with Nebuhaler. In terms of bronchodilator effect Nebuhaler had definite advantage over tube spacer in our study. There were no significant changes in pulse rate nor in blood pressure.
Administration, Inhalation↗