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PubMedDate not supplied

Radioiodine uptake in the head and neck.

OBJECTIVE: To report two cases of sinusitis-associated radioiodine uptake in patients with thyroid cancer and to review the reported causes of false-positive radioiodine uptake in the head and neck area. METHODS: We present the radiologic findings in two patients who had undergone treatment for papillary thyroid cancer and discuss other settings in which radioiodine uptake suggested the presence of metastatic disease. RESULTS: Radioiodine whole-body scans of two patients who had had thyroid cancer demonstrated uptake in the sphenoid and maxillary sinuses, respectively, mimicking bone or brain metastatic involvement. The thyroglobulin levels were low. Computed tomographic (CT) scanning disclosed mucosal swelling in the sinuses, consistent with sinusitis. The radioiodine uptake cleared on a follow-up scan in one case and was more localized than the CT findings in the other. Eighteen causes of false-positive radioiodine uptake in the head and neck area have been reported. On the basis of the mechanism of uptake, they can be classified into four categories: (1) physiologic uptake (ectopic thyroid tissue), (2) nonthyroidal pathologic conditions (dacryocystitis, sinusitis, sinus mucocele, sialadenitis, folliculitis, Warthin's tumor, parotid cyst, porencephaly, posttraumatic cerebromalacia, and inflammation due to dental disease or a nose ring), (3) internal retention (ectasia of the carotid artery and an artificial eye), and (4) external contamination by body secretions (sweat and nasal, tracheobronchial, lacrimal, and salivary secretions). The estimated prevalence of external contamination in the head and neck area on whole-body radioiodine scans is 0.3%. CONCLUSION: Physicians should rule out the presence of radioiodine uptake by inflamed mucosa of the paranasal sinuses, as well as various other causes of false-positive radioiodine uptake, before metastatic thyroid cancer in the head and neck area is diagnosed.

Carcinoma, Papillary↗
PubMed2004

[Transcanalicular dacryocystorhinostomy technique using diode laser].

PURPOSE: To describe the surgical technique and to evaluate the clinical results of carrying out transcanalicular dacryocystorhinostomies using a diode laser (DCR-TC), including the advantages and limitations of this technique. METHODS: 43 DCR-TC were studied and they were analysed using a prospective, interventional, non randomized and non comparative study. We used local and topical anaesthesia in patients with a clinical history of epiphora or dacryocystitis for nasolacrimal obstruction. A diode laser was used to effect a vaporization of the lacrimal sac, osteotomy and vaporization with coagulation of nasal mucosa. The mean duration of surgery was 14 minutes (range 7 to 29 minutes). In all cases, and during a two-month period, bicanalicular intubation was carried out using a silicone tube and prolene filament. Follow-up was between 4 to 38 months. The degree of epiphora was evaluated using the Munk scale and lacrimal permeability was evaluated using Jones I and II tests by direct videoendoscopic control in all cases. RESULTS: 43 DCR-TC were realized, 39 cases are asymptomatic (90.7%). 2 of them (4.65%) had epiphora (degree 2 on the Munk scale) and permeable tract. One case (2.32%) presented lower canaliculi obstruction. One patient showed total osteotomy closing. CONCLUSIONS: Transcanalicular dacryocystorhinostomy carried out using a diode laser is a useful method because it does not cause cutaneous scarring, it hardly produces pain and bleeding, it respects the lacrimal pump, it needs less surgical time, it can be carried out in an out-patient surgery and it generates minimal intra and postsurgical morbility.

Adult↗
PubMed2004

[Treatment of nasolacrimal duct obstruction with Song's stent. Long term efficacy].

PURPOSE: To evaluate the long-term efficacy (5 years) of Song's stent in the treatment of naso-lachrymal duct obstruction. MATERIALS AND METHODS: We examined Song's stents installed in 64 eyes from 62 patients with naso-lachrymal duct obstruction (NLD). Of the 64, 48 were women and 14 men of mean age 60 SD 13.17 years. Obstructions of right side 62.5% and left side 37.5%, and location in dacriocystography: sac-NLD junction 82.8%, distant NLD 10.9%, medium NLD 3.1% and both proximal and complete NLD 1.6%. CLINICAL PRESENTATION: chronic epiphora 96.8%, acute dacriocystitis 67.2%, purulent discharge 25% and mucocele 17.2%. Mean follow-up period was 25.23 months. RESULTS: 13 stents were removed and 2 changed during the follow-up. 67.2% were patent at the end of the study; epiphora reduced to 32.8%, number of acute dacryocystitis, purulent discharge and mucocele to 1.6%. Subjective improvement was found in 73.5%. Surgical complications included epistaxis (15.6%) and pain (14.1%), and post-operative complications included reobstruction in 22 cases within a mean time of 8.6 months. CONCLUSIONS: Song's stent is a quick and useful option in treatment of epiphora. Despite not being efficient in all cases, it leads to improvement of symptoms and avoidance of surgery in the majority of cases. However, it requires periodical washes to maintain its patency.

Adult↗
PubMed1976

[Ophthalmic application of intravenous cephradine (author's transl)].

Basic and clinical experiments were performed on intravenous cephradine (CED) in ophthalmological field. The results are summarized as follows. 1. Serum concentration: After intravenous injection of 1.0 g CED, in a single dose, to a healthy adult, the peak of serum level (34.0 mug/ml) was attained at 15 minutes, then decreased quickly to 2.3 mug/ml by 6 hours. 2. Ocular penetration in rabbit eye: (1) Aqueous humor concentrations: The peak level of aqueous humor (13.45 mug/ml) was obtained at 30 minutes after intravenous injection of 50 mg/kg, in a single dose. Aqueous/Serum ratio was 38.07%. After instillation of 5 mg/ml solution of CED, 5 times every 5 minutes, the aqueous level was recognized 30 minutes and 1 hour, and no detectable 4 hours. After 50 mg/0.5 ml CED subconjunctival injection, in a single dose, the high aqueous levels were observed at 30 minutes and 1 hour, and still detectable 4 hours later. (2) Ocular tissue concentrations: The ocular tissue concentrations at 30 minutes after intravenous injection of 50 mg/kg CED were high in both outer and inner parts of the eye. After 4 hours, the tissue levels remained relatively high concentrations. (3) CLINICAL RESULTS: Intravenous administration of 0.5, 1.0 or 2.0 g CED 1 or 2 times daily revealed excellent or good effects in 8 of 12 cases, such as external hordeolum, internal hordeolum, lid abscess, chronic dacryocystitis, orbital abscess and corneal ulcer. (4) Side effects: Three cases out of 12 complained burning sensation by intravenous injection of CED, but in neither case was it found necessary to withdraw the drugs. No severe side effects such as allergic reactions were observed. No abnormal findings in hepatic and renal function tests were observed.

Adult↗
PubMed1999

A result of sublabial transnasomaxillary approach for nasopharyngeal angiofibroma--retrospective study.

To evaluate the result of sublabial transnasomaxillary approach (STA) as a route for removal of juvenile nasopharyngeal angiofibroma (JNA). Eleven young male patients with angiofibroma underwent removal via the sublabial transnasomaxillary approach. This technique is described in detail. There was neither major operative nor postoperative complication. One patient developed dacryocystitis. Long term follow-up longer than 18 months in 5 patients, showed no recurrence. This technique is useful for removal of angiofibroma because it enables the surgeon to gain extensive exposure of maxillary, ethmoid and sphenoid sinuses and to control sphenopalatine and internal maxillary arteries, without risk of palatal dysfunction or of oronasal fistula. Other advantages comprise the lack of a facial scar, nasal septal scar and bilateral premaxillar numbness, and good postoperative assessment.

Adolescent↗
PubMed2001

Review of the diagnosis and management of acquired nasolacrimal duct obstruction.

BACKGROUND: Acquired nasolacrimal duct obstruction is a common cause of epiphora. The absolute or partial blockage of the nasolacrimal duct occurs most frequently in middle-aged and elderly women. In addition to the troublesome symptom of epiphora, acquired nasolacrimal duct obstruction is predominantly the underlying cause of both acute and chronic dacryocystitis. METHODS: The primary eye care provider plays an essential role in the diagnosis and management of the patient with epiphora. The potentially serious ramifications of acquired nasolacrimal duct obstruction demand a thorough understanding of the clinical presentation of this disorder. In addition, it is essential the optometrist be well-acquainted with the surgical treatments often necessary for optimal management. CONCLUSION: Whether treatment is provided or an appropriate referral is made, the optometrist is instrumental in providing care for the patient who experiences an acquired nasolacrimal duct obstruction.

Biocompatible Materials↗
PubMed2001

[A case of suspected drug-induced ocular pemphigoid].

BACKGROUND: Lacrimal obstruction can occur as a complication of ocular cicatricial pemphigoid. We report a patient who was diagnosed as having drug-induced ocular cicatricial pemphigoid associated with acquired lacrimal canalicular obstruction in spite of relatively mild subconjunctival scar formation. CASE: The patient was a 69-year-old woman. She had been treated for glaucoma, blepharoconjunctivitis, dacryocystitis, and lacrimal canalicular obstruction for two years with topical administration including 0.5% timolol maleate, 0.1% dipivefrine hydrocholoride, 0.1% fluorometholone, and 0.3% ofloxacin. The patient had moderate conjunctival hyperemia without shortening of the inferior conjunctival sac, corneal ulceration, neovascularization, and keratinization. Lacrimal canalicular obstruction progressed further as topical ocular medications were continued. Topical anti-glaucoma medications were stopped after dacryocystorhinostomy. Although the blepharoconjunctivitis was improved, left inferior conjunctival symblepharon, and medical canthal keratinization was progressive despite the use of topical corticosteroids. The conjunctival biopsy specimen showed the lacrimal punctum covered with proliferated conjunctival epithelium. There was a moderate stromal infiltration of small lymphocytes and plasma cells. We diagnosed this patient as having drug-induced ocular cicatricial pemphigoid caused by topical anti-glaucoma medications. CONCLUSION: Lacrimal canalicular obstructions may occur with the topical anti-glaucoma medications even when subconjunctival scarring is mild.

Aged↗
PubMed2001

[Endonasal dacryocystorhinostomy (DCR)].

The main symptoms of chronic obstruction of lacrymal pathways are epiphora and chronic dacryocystitis occurring mostly in elderly women. The aim of the surgery is to perform intranasal drainage of the lacrymal sac. The authors performed 30 dacryocystorhinostomies (DCR) in 26 patients with an intranasal endoscopic approach. 24 DCR with a mean follow-up of 25 months and a success rate of 91.7% after one single procedure are discussed. Among three current surgical techniques, the endonasal approach has been shown to be a safe and effective method with many advantages compared to the external transcutaneous way.

Adult↗
PubMed2000

Possibilities and limits of minimal invasive lacrimal surgery.

Endoscopy of the lacrimal drainage system with miniaturized endoscopes has been possible since 1990 and permits the direct evaluation of the lacrimal drainage system. Additionally, attached instruments permit recanalization in cases of stenosis of the lacrimal drainage system. Both an Erbium-Yag Laser and a miniaturized drill are available, with which a stenosis of the lacrimal drainage system can be opened under endoscopic control. Favorable findings for endoscopic recanalization are stenoses in the area of the canaliculi or the lacrimal sac, for which the success rate of recanalization is approximately 75%. Unfavorable prognostic factors are submucous scar formations due to a dacryocystitis in the patient's history. Endoscopic findings have also improved the understanding of diseases of the lacrimal drainage system. Punctal stenoses causing epiphora often show intact mucous membranes before and behind the stenosis and it is possible to cure these patients without extensive surgical procedures. Micro-surgical procedures and dacryocystorhinostomy complete the spectrum of the endoscopic surgical possibilities in the lacrimal drainage system.

Journal Article↗
PubMedDate not supplied

[Treatment of lacrimal duct diseases using low energy helium-neon laser].

Treatment of diseases of the lacrimal duct remains a pressing problem in ophthalmology. These diseases are responsible for 71-85.4% diseases in capable people. Sixty patients with chronic dacryocystitis with partially retained patency of the lacrimal duct were treated by He-Ne low-frequency laser ULF-01 (output power 6.10 mcWt, laser beam wave length 0.632 nm). The patients received 3-5 min sessions twice a week, 5-8 sessions per course. Positive effect was attained in 56 patients: complete cessation of excessive lacrimal discharge in 38 patients and subjective improvement in 18. He-Ne laser exposure brings about a good antiinflammatory effect; in combination with antibiotic therapy it promotes rapid sanitization of the lacrimal duct, removes edema, and rapidly normalizes lacrimal discharge.

Helium↗
PubMed2002

Nasal dermoid cyst: diagnosis and management of five cases.

Five cases of nasal dermoid cyst are presented. Three out of five cases were settled during childhood. Three presented a mass with a hole on the external nose with recurrent local infections. One case was wrongly referred for a dacryocystitis. The first one was detected during an infection of the cerebral extension and frontal abscess was assessed by CT scan and MRI. Two patients had other associated congenital abnormalities: hypotrophy of the external ear in one case, multiples malformations in an other. Adequate exposure and cosmetic results are sometimes contradictory to define the best surgical approach. Dermoid cysts and sinuses must be completely removed to prevent recurrence. External rhinoplasty and bicoronal approach are the main procedures for removing these lesions.

Adult↗
PubMed2003

The human nasolacrimal ducts.

The human nasolacrimal ducts are a borderland of the disciplines ophthalmology and otorhinolaryngology, which work close together in the treatment of nasolacrimal disorders. However, little knowledge exists concerning the physiology of the nasolacrimal system and, therefore, its pathophysiology. The aim of the present investigations was to obtain a better understanding of tear flow physiology, microbial defence strategies and pathophysiological processes by analysing the nasolacrimal system, thus opening new perspectives against existing therapeutical concepts of diseases of the nasolacrimal ducts. The human nasolacrimal ducts consist of the upper and the lower lacrimal canaliculus, the lacrimal sac and the nasolacrimal duct. They drain the tear fluid from the ocular surface into the lower meatus of the nose. The lining epithelium of the lacrimal sac and the nasolacrimal duct is faced by microvilli, and animal experiments in rabbits support the hypothesis that tear fluid components are absorbed in the human nasolacrimal system. Evidence of seromucous glands, intraepithelial lipids and a specific mucus layer leads to the conclusion that the normal three-layering of the tear film is also present in the nasolacrimal ducts. Based on its composition, the mucus layer, which is mainly synthesised by goblet cells and intraepithelial mucus glands, functionally serves as a simplified drainage of tear fluid, and it is attributed similar properties to epithelia of the gastrointestinal tract. Further defence mechanisms are represented by antimicrobial peptides IgA and immunocompetent cells (lymphocytes and macrophages) which show intraepithelially and subepithelially a special distribution. Moreover, organised lymphoid tissue is present, which reveals the cytomorphologic and immunophenotypic characteristics of mucosa-associated lymphoid tissue. The wall of the lacrimal sac and the nasolacrimal duct are made up of a helical system of different connective tissue fibres. Wide luminal vascular plexus are embedded in this helical system, which is comparable to a cavernous body. Caudally, the vascular system is connected to the cavernous body of the inferior turbinate. With distension the system may be "wrung out" due to its medial attachment and helically arranged fibrillar structures. Thereby, tear fluid is drained distally. The embedded blood vessels underlie vegetative control. By means of this innervation, the specialised blood vessels permit regulation of blood flow by opening and closing the lumen of the lacrimal passage as effected by the engorgement and subsidence of the cavernous body, at the same time regulating tear outflow. Related functions, such as a role in the occurrence of epiphora related to emotional responses, are relevant. Moreover, malfunctions in the cavernous body and in its innervation may lead to disturbances in the tear outflow cycle, ocular congestion or total occlusion of the lacrimal passage. Thus, the pathophysiology of primary acquired dacryostenosis can be explained: Descending inflammation from the eye or ascending inflammation from the nose initiates swelling of the mucous membrane, remodelling of the helical arrangement of connective tissue fibres, malfunctions in the subepithelial cavernous body with reactive hyperaemia, and temporary occlusion of the lacrimal passage. In the follow-up, repeated isolated occurrence of dacryocystitis leads to structural epithelial and sub-epithelial changes, which may lead either to a total fibrous closure of the lumen of the efferent tear duct or to a non-functional segment in the lacrimal passage that is manifest on syringing. The normally constant absorption of tear fluid components into the blood vessels of the surrounding cavernous body that are connected to the blood vessels of the outer eye could be a feedback signal for tear fluid production, which comes to a halt if these tear components are not absorbed. Thus, dry eye could be initiated. Defective stimulation of tear duct-associated lymphoid tissue (TALT) could result in abnormal immune deviation at the ocular surface leading to an autoimmunologic response that could cause dry eye pathology.

Humans↗
PubMedDate not supplied

Frequency of ocular complications of leprosy in institutionalized patients in NWFP Pakistan.

BACKGROUND: There is no systemic disease, which so frequently gives rise to disorders of the eye as leprosy does. The study was conducted to determine the prevalence and gravity of ocular complications in institutionalized leprosy patients in NWFP. It is important to provide necessary information to leprosy health workers and general physicians in order to sensitize them to early detection and treatment or referral to appropriate centre. METHODS: A prospective study of ocular complications of leprosy patients was conducted at the leprosy centre of Lady Reading Hospital Peshawar and the Leprosy Hospital Balakot, district Mansehra. The study included a record of the name, age, sex, type, duration of disease and completion of multi-drug therapy (MDT). Classification of the patients was done according to Ridley and Jopling 5-group system. Visual acuity was tested by Snellen chart and those patients having a vision of less than 3/60 were labelled as blind. Ocular adnexa were examined by naked eye and lacrimal sac regurgitation test was done. Slit lamp biomicroscopy was done for anterior segment examination and direct ophthalmoscope was used for fundoscopy. RESULTS: The authors studied 143 patients in the above mentioned leprosy centres. Out of these, 59 had lepromatous leprosy, 39 borderline tuberculoid leprosy, 9 tuberculoid leprosy, 33 borderline lepromatous leprosy, and 33 borderline leprosy. The majority of patients came from the northern districts of NWFP, including Malakand division and district Mansehra. The male to female ratio was 4:1. The age of the patients ranged from 14 to 80 years and the duration of the disease ranged from 1 year to 48 years. Ocular complications were found in 73% of the patients. These complications included loss of eyebrows in 57 patients, loss of eyelashes in 37, corneal changes (including opacity, ulceration, and/or anaesthesia) in 44, iridocyclitis in 31, lagophthalmos in 36, ectropion in 13, and chronic dacryocystitis in 3. Of the total of 15 (11%) patients who went blind from ocular complications, 16 eyes did so due to corneal opacities, 6 eyes due to cataract, 5 eyes due to chronic anterior uveitis and one eye due to corneal ulcer, panophthalmitis and phthisis bulbi each. CONCLUSIONS: A significant number of leprosy patients (73%) have ocular complications. The frequency of ocular complications increases with the increasing age and duration of disease of the patients.

Adolescent↗
PubMed2002

Endonasal endoscopic dacryocystorhinostomy.

A review of endoscopic dacryocystorhinostomy (EDCR) performed in University Hospital from 1998 till early 2001 were carried out. They were reviewed for indication, functional results, complications and other associated factors. Eleven patients (6 female and 5 male) were reviewed. All had unilateral nasolacrimal duct (NLD) obstruction (6 right, 5 left). Their ages range from 6 to 73 years. All 11 had persistent epiphora while 4 had concurrent recurrent dacryocystitis with purulent discharge. Two patients had history of lacrimal sac abscess that needed drainage. Ten patients had the procedure performed successfully. Functional results were excellent in 8 patients (80%) while two patients still had occasional epiphora although markedly reduced. Complications include synachae (1 patient), premature dislodgement of Jones tube (1 patient) and impacted tube in a child. Our experience with EDCR concludes it to be an easy, efficient treatment for nasolacrimal duct obstruction with minimal complications.

Adolescent↗
PubMed2003

[Dacryolithiasis: diagnosis using nasal endoscopy].

PURPOSE: The purpose of this study was to assess the value of two new clinical findings for the diagnosis of dacryolithiasis discovered with nasal endoscopy: anatomical abnormalities of the Hasner valve (HV) and mucopurulent discharge visible at this valve. The value of these findings is compared with other clinical and radiological signs of dacryolithiasis. A hypothesis is developed as to the responsibility of the HV in the formation of dacryolithiasis. METHOD: This study was prospective and based on 797 operations performed for epiphora: 647 endonasal dacryocystorhinostomies and 150 meatotomies of the HV, with systematic preoperative nasal videoendoscopy. Ninety dacryocystographies (DCGs) and 129 lacrimal computed tomographies (LCT) were preoperatively performed. RESULTS: Dacryoliths were found in 55 of 797 patients (6.9%). The HV could be examined in 48 patients in the lithiasis group and in 687 patients in the control group. Mucopurulent discharge was observed in 22 patients with lithiasis (45.8%) and in 40 patients (5.8%) (p<10(-6)) of the control group. Anatomical abnormalities of the HV were found in 40 patients with dacryolithiasis (83.3%) as compared to 82 patients ing the control group (11.4%) (p<10(-6)). In 13 patients, the VH was very small (<2 mm), in 12 patients it was very long (>15 mm), and in 15 patients both abnormalities were observed. Other clinical signs were young age (mean, 48.2 years vs 59.1% in the control group) (p<0.05), a history of acute noninfectious dacryocystic retention (38.2% vs 9.5%) (p<10(-5)), partial obstruction of the lacrimal pathway (LP) (61.8% vs 30.5%) (p<10(-5)). The 28 LCTs that were performed in subjects who had lithiasis made it possible to diagnose 19 cases of dacryolithiasis and confirmed abnormalities of the HV causing narrowing of the LP in 20. CONCLUSION: Dacryolithiasis is frequent and often misdiagnosed. When dacryolithiasis is suspected, a nasal videoendoscopic exam must be done to seek HV abnormalities and mucopurulent discharge at this valve. This latter finding, i.e., the association of mucopurulent discharge with a patent lacrimal system, has high specificity. The finding of numerous anatomical abnormalities of the HV may be an indication that congenital malformation of the HV is the cause of many cases of lithiasis.

Adult↗
PubMed2003

Paediatric endoscopic sinus surgery (PESS): review of the indications.

Functional endoscopic sinus surgery (FESS) differs in children and adults. The purpose of this article is to highlight the differences by focusing on the anatomical landmarks and diagnostic and surgical peculiarities present in children. We review the indications of FESS in children, partially based on our personal experience, in order to establish a list of relative and absolute indications for the procedure. We also discuss controversies such as the overuse of FESS for chronic sinusitis and the potential postoperative alterations of pneumatization. The paper includes a retrospective study of our results with endoscopic dacryocystorhinostomy (DCR) in 31 children and the endoscopic removal of 11 juvenile angiofibromas. All patients were reviewed in the out patients clinic. Patency of DCR was evaluated by fluorescein dye application to the conjunctiva, endoscopy with a 2.7 mm rigid endoscope or by means of clinical parameters, such as tearing or recurrent dacryocystitis. For patients operated on for a juvenile angiofibroma endoscopy of the nose and MRI every 6 months for the first two years were scheduled. Functional outcome showed good overall results in 90.3% of DCR after primary surgery. The endoscopic approach to juvenile angiofibromas achieved a cure rate of 90.9% after a follow-up of at least 24 months.

Adolescent↗
PubMedDate not supplied

Long-term results of external dacryocystorhinostomy.

BACKGROUND AND OBJECTIVE: To evaluate the long-term success following external dacryocystorhinostomy, which is used as a standard in comparing endoscopic or laser techniques. PATIENTS AND METHODS: A chart review of 128 patients (150 procedures) undergoing external dacryocystorhinostomy within a 14-year period was undertaken. Patient demographics, symptoms, examination findings, surgical and anesthesia information, postoperative course, and complications were recorded. Lack of tearing or evidence of dacryocystitis at the final postoperative visit was considered a successful result. RESULTS: External dacryocystorhinostomy was found to be highly successful, with an overall 93% success rate at an average follow-up of 2.7 years. Kaplan-Meier analysis of the data, applied for the first time in this study, predicts a success rate of 90% beyond 4 years. Most important, this demonstrated that most surgical failures were identified in the first 2 years. Postoperative complications were rare and the surgical scar was not a source of patient concern in most cases. CONCLUSIONS: This study confirms that external dacryocystorhinostomy is a highly successful long-term solution to nasolacrimal duct obstruction with low morbidity.

Adolescent↗