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Biomedical subjects

M V Kirtane

Publications and source records attributed to M V Kirtane.

At least 19 recordsLinked to original sources
PubMed2004

Mondini dysplasia and pyogenic meningitis.

Mondini dysplasia with cerebrospinal fluid leak is a rare cause of recurrent pyogenic meningitis in children. We describe an eleven-year-old female child who presented with the fifth recurrent episode of pyogenic meningitis and unilateral sensorineural deafness. Mondini dysplasia of the inner ear with CSF-perilymph fistula was proven on an HRCT of the temporal bone and MRI. Successful operative intervention was undertaken to close the defect. Though rare, Mondini dysplasia should be considered as a cause of recurrent meningitis in children, especially if they have sensorineural deafness.

Cerebrospinal Fluid Otorrhea↗
PubMed2001

Tubercular laryngeal abscess.

Tuberculosis, with its varied presentations and numerous complications, is a relatively common disease in developing countries like India. Amongst its many presentations, pulmonary tuberculosis is the commonest. A tubercular laryngeal abscess is an extremely rare entity. We report a 37-year-old male, diagnosed with a tubercular laryngeal abscess which was successfully treated under local anaesthesia by incision and drainage and in whom a tracheostomy could be avoided.

Abscess↗
PubMed2000

A retrospective analysis of spontaneous sphenoid sinus fistula: MR and CT findings.

BACKGROUND AND PURPOSE: The sphenoid sinus is rarely implicated as a site of spontaneous CSF fistula. We undertook this study to evaluate the potential etiopathogenesis of spontaneous CSF fistula involving the sphenoid sinus and to review the imaging findings. METHODS: We retrospectively reviewed the imaging findings of 145 cases of CSF fistula from our departmental archives (August 1995 through August 1998). Fifteen (10%) patients had CSF fistulas involving the sphenoid sinus. Eleven (7%) patients had spontaneous CSF fistulas, whereas in four patients, the CSF fistulas in the sphenoid sinus were related to trauma. Of the 11 patients, nine underwent only plain high-resolution CT and MR cisternography. One patient additionally underwent contrast-enhanced CT cisternography, and one other patient underwent MR cisternography only. For each patient, the CSF fistula site was surgically confirmed. The MR imaging technique included T1-weighted and fast spin-echo T2-weighted 3-mm-thick coronal sequences obtained with the patient in the supine position. The plain high-resolution CT study included 3-mm-thick, and sometimes 1- to 1.5-mm-thick, coronal sections obtained with the patient in the prone position. Similar sections were obtained after injecting nonionic contrast material intrathecally via lumbar puncture for the CT cisternographic study. We evaluated each of the 11 patients for the exact site of CSF leak in the sphenoid sinus. We also determined the presence of pneumatization of lateral recess of the sphenoid sinus, orientation of the lateral wall of the sphenoid sinus, presence of arachnoid pits, presence of brain tissue herniation, and presence of empty sella in each of these patients. RESULTS: The exact sites of the CSF fistulas were documented for all 11 patients by using plain high-resolution CT, MR cisternography, or CT cisternography. In nine (82%) patients, the sites of the CSF fistulas were at the junction of the anterior portion of the lateral wall of the sphenoid sinus and the floor of the middle cranial fossa. In the remaining two (18%) patients, the sites of the CSF fistulas were along the midportion of the lateral wall of the sphenoid sinus. Of these 11 patients, one had bilateral sites of the CSF fistula at the junction of the anterior portion of the lateral wall of the sphenoid sinus with the floor of the middle cranial fossa. In nine (82%) patients, the presence of brain tissue herniation was revealed, and this finding was best shown by MR cisternography. Ten (91%) patients had extensive pneumatization of the lateral recess of the sphenoid sinus, with an equal number having outward concave orientation of the inferior portion of the lateral wall of the sphenoid sinus. In seven (63%) patients, the presence of arachnoid pits, predominantly along the anteromedial aspect of the middle cranial fossa, was shown. In seven (63%) patients, empty sella was shown. For comparison, we reviewed the CT studies of the paranasal sinuses in 100 age-matched control subjects from a normal population. Twenty-three had extensive lateral pneumatization of the sphenoid sinus along with outward concavity of the inferior portion of the lateral wall. None of these 23 patients had arachnoid pits. CONCLUSION: The sphenoid sinus, when implicated as a site of spontaneous CSF leak, yields a multitude of imaging findings. These are extensive pneumatization of the lateral recess of the sphenoid sinus, outward concave orientation of the inferior portion of the lateral wall of the sphenoid sinus, arachnoid pits, and empty sella. Considering the normative data, we speculate that this constellation of findings could play a role in the etiopathogenesis of spontaneous sphenoid sinus fistulas. Our findings also show the efficacy of noninvasive imaging techniques, such as plain high-resolution CT and MR cisternography, in the evaluation of sphenoid sinus CSF leak. Our data also suggest that spontaneous sphenoid sinus CSF leak is not an uncommon occurrenc

Adult↗
PubMed2000

HCFA tightens eligibility requirements for provider-based status.

On October 10, 2000, HCFA will implement new eligibility standards for all off-campus entities with a provider-based designation. Providers that wish to retain the provider-based status of their ambulatory care facilities need to take action to more fully integrate the ambulatory care facilities with their main facilities. In addition, the provider will need to show that 75 percent of the patient population served by the ambulatory care facility also is served by the provider's main facility.

Ambulatory Care Facilities↗
PubMed2000

Pre and post betahistine therapy 99m Tc - HMPAO brain spect studies in patients with vertigo.

Vertebro basilar insufficiency (VBI) is a well known cause of vertigo. Brain Single Photon Emission Computed Tomography (SPECT) is an important diagnostic tool to detect and to quantitate the perfusion abnormalities in different areas of the brain. Effect of an antivertigo drug Betahistine on improving the hypoperfusion in different areas of the brain in vertigo patients was studied using brain SPECT. Betahistine at a dose of 16 mg three times daily was shown to improve perfusion in the hypoperfused areas of the brain resulting in relief from symptoms of vertigo. The cerebellar region, which is the most important area involved in vertigo patients with vascular pathology, showed almost complete normalisation of perfusion following Betahistine therapy.

Betahistine↗
PubMed1998

Evaluation of high-resolution CT and MR cisternography in the diagnosis of cerebrospinal fluid fistula.

PURPOSE: We undertook this study to determine the accuracy of MR cisternography and plain high-resolution CT as a noninvasive alternative to CT cisternography in the diagnosis of CSF fistula in patients with clinically suspected CSF rhinorrhea. METHODS: Forty-five consecutive patients with clinically suspected CSF rhinorrhea were examined prospectively for CSF fistula with MR cisternography and plain high-resolution CT. Twenty-one patients also underwent CT cisternography. The MR imaging technique included 3-mm thin-section T1-weighted coronal sequences and fast spin-echo T2-weighted coronal, axial, and sagittal sequences in the supine position. The plain high-resolution CT study included 3-mm and sometimes 1- to 1.5-mm thin coronal sections in the prone position. Similar sequences were used after injecting nonionic contrast material intrathecally via lumbar puncture for the CT cisternographic study. The plain high-resolution CT and MR cisternographic studies were compared with results of CT cisternography; surgical findings were used as the standard of reference. RESULTS: Plain high-resolution CT successfully depicted the presence or absence of CSF fistula in 42 of 45 patients, whereas MR cisternography was correct in 40 patients. MR cisternography or plain high-resolution CT correctly showed the site(s) of CSF fistula leakage in 36 of the 38 cases proved surgically. The combined techniques also correctly indicated the absence of CSF leakage in seven cases, six of which were confirmed at CT cisternography. Both MR cisternography and high-resolution CT failed to definitively locate the CSF fistula in two patients. High-resolution CT was accurate in 93% of patients, whereas MR cisternography was accurate in 89% of patients. The combination of high-resolution CT and MR cisternography was accurate in 96% of patients. CONCLUSION: In the presence of clinically diagnosed CSF leakage, the combination of MR cisternography and plain high-resolution CT is highly accurate in locating the site and extent of CSF fistula and should be considered a viable noninvasive alternative to CT cisternography.

Adolescent↗
PubMed1997

Cerebrospinal fluid otorhinorrhea in patients with defects through the lamina cribrosa of the internal auditory canal.

We describe three patients with bilateral cerebrospinal fluid (CSF) otorhinorrhea with unilateral progressive hearing loss in whom CT showed the defect to be located in the lamina cribrosa of the internal auditory canal. CT cisternography showed the CSF fistula in two of the three patients who had Mondini malformation, whereas the CSF fistula was obvious on the plain high-resolution temporal bone CT study in the third patient, who had a posttraumatic (nonsurgical) fracture of the lamina cribrosa. Fast spin-echo T2-weighted coronal MR cisternography also showed the site of leakage in the third patient. In the presence of an intact tympanic membrane, the CSF egressed to the nose via the eustachian tube in all three patients.

Adult↗
PubMed1995

Allergic fungal sinusitis: incidence and clinical and pathological features of seven cases.

Allergic fungal sinusitis, like allergic bronchopulmonary fungal disease, is a noninvasive inflammatory process. It manifests as recurrent nasal polyposis. Histologically the characteristic feature is the presence of thick mucin with dense collections of degenerating eosinophils and Charcot-Leyden crystals (allergic mucin). Demonstration of fungal hyphae in allergic mucin is diagnostic of the disease. We reviewed 85 cases of nasal polyposis operated upon during a period of four years. Allergic fungal sinusitis was diagnosed in seven (8.2%) cases on the basis of presence of allergic mucin and fungal hyphae. History of previous nasal polypectomy was present in four of the seven cases, and in six of the remaining 78. There were no clinical or radiological features that could distinguish the cases of allergic fungal sinusitis from the rest. Aspergillus fumigatus, Mucor and Cladosporium were cultured from one case each.

Adult↗
PubMed1992

Rhinocerebral mucormycosis: an unusual case presentation.

Rhinocerebral mucormycosis is a rapidly fatal fungal disease which involves the nose, paranasal sinuses, orbit and central nervous system. The fungal infection is usually secondary to immunosuppression, diabetic acidosis, or antibiotic, steroid or cytotoxic therapy. It can also occur in patients suffering from burns, malignancy and haematological disorders. Current treatment consists of correction of the underlying disorder, repeated debridement of the wound in combination with intravenous amphotericin B. This paper describes our experience with a case of rhinocerebral mucormycosis. This is an unusual case in which mucormycosis was seen in a young female where no underlying cause was found. She responded to surgical debridement in combination with intravenous amphotericin B.

Adult↗
PubMed1991

Fracture line in post head injury optic nerve damage.

Diminution of vision following head injuries involving the optic canal is not uncommon. In order to find out how a blunt trauma to the frontotemporal region produced damage to the optic nerve in its canalicular portion, this study was conducted on cadaveric skulls and its results are described.

Blindness↗
PubMed1991

Transethmoid decompression of the optic nerve in head injuries: an update.

Sixty-three patients with loss of vision following head injury were subjected to decompression of the optic nerve by the transethmoid route. This paper discusses the criteria for selection of patients for surgery, the results of the operation and the prognostic factors determining the results.

Adolescent↗
PubMed1991

Functional endoscopic sinus surgery--I (Anatomy, diagnosis, evaluation and technique).

It has been proved beyond doubt that the causation and perpetuation of disease in the dependent sinuses (maxillary and frontal sinuses) is secondary to disease of the ostiomeatal complex, the primary focus of which is the anterior ethmoid. Based on this concept, functional endoscopic sinus surgery (FESS) aims at correcting the underlying pathology in the ethmoids and helps to re-establish normal ventilation and mucociliary clearance of the dependent sinuses.

Combined Modality Therapy↗
PubMed1991

Functional endoscopic sinus surgery--II (A preliminary study).

Seventy-eight patients of chronic sinusitis were subjected to functional endoscopic sinus surgery by the technique described in the previous paper. The clinical features, findings at surgery and the results of this technique are described here.

Adolescent↗