Hesham Negm

Orbital and periorbital vascular anomalies--an approach to diagnosis and therapeutic concepts.

Abstract Conclusion: A correct and universally accepted terminology based on the biologic behavior of orbital vascular anomalies is essential to avoid misleading diagnoses, to choose an adequate therapy regimen, and to compare different therapeutic approaches. The management of these diseases is multi-modal and an interdisciplinary challenge. Background: There is persisting terminological and clinical confusion about vascular anomalies involving the orbit. Review of the literature reveals a diverse or misleading terminology and a lack of consensus for the treatment of vascular malformations or vascular tumors of the orbit. Methods: This study comprised a detailed analysis of cases presenting with orbital vascular anomalies followed by an extensive review of the literature. Results: Thirty-six patients were analyzed, among them 19 patients with peri- and/or intraorbital hemangiomas, 3 with intraorbital and 2 with periorbital venous malformations, 2 with orbital involvement of complex vascular malformations, and 10 with lymphatic malformations involving the orbit.

Lack of significant estrogen and progesterone receptor expression in nasal telangiectasias in hereditary hemorrhagic telangiectasia: An immunohistochemical analysis

Abstract Conclusion: This immunohistochemical study of estrogen and progesterone receptors could not confirm a significant expression in nasal telangiectasias. Thus, a specific effect of these hormones or anti-hormone therapy on malformed nasal vessels has to be questioned and only offered under strict clinical control. Objective: The efforts to control recurrent epistaxis in hereditary hemorrhagic telangiectasia (HHT) using alternative methods are very intense. Hormone or anti-hormone therapy has frequently been postulated and the reported results are controversial. Therefore it was important to find an explanation regarding a possible impact of hormonal therapies by immunohistochemical evaluation of progesterone and estrogen receptor expression on nasal telangiectasias of affected patients. Methods: Tissue samples of nasal mucosa with evidence of telangiectasias from 14 patients with HHT were analyzed for the expression of progesterone and estrogen receptors on the nuclei of endothelial cells of the malformed vessels using immunohistochemistry. Results: Progesterone receptors were not detected in any of the cases and only two cases showed a weak expression of estrogen receptors with an immunoreactive score of 2/12.

Factors affecting secondary post-tonsillectomy hemorrhage: a case–control study

Background: Tonsillectomy is one of the commonest otolaryngological procedures performed. Multiple reports have demonstrated the safety of ambulatory (outpatient) pediatric Tonsillectomy, however Post-tonsillectomy hemorrhage remains the most serious complication of tonsillectomy. Patients and methods: In this work, we analyzed different parameters including patient’s age, gender, type of surgery “Tonsillectomy or Adenotonsillectomy”, technique “Cold dissection or Bipolar”, evidence of tonsillar bed infection and pre-operative hemoglobin level in two groups of patients indicated for tonsillectomy. One group of 80 patients didn’t suffer from posttonsillectomy bleeding as a control group; the other of 20 patients having secondary post-tonsillectomy bleeding. Results: According to our statistical analysis and data, no significant difference between the two groups regarding the occurrence of secondary post-tonsillectomy in the following parameters: patient’s age, gender, type of surgery “Tonsillectomy or Adenotonsillectomy” and preoperative hemoglobin level. Conclusion: However there was higher incidence of secondary post tonsillectomy bleeding in patients operated by bipolar scissors. Also evidence of tonsillar bed infection raises the possibility of secondary post-tonsillectomy bleeding occurrenc.

Olfactory function after total laryngectomy

Objective The aim of this study was to assess the olfactory function in patients who underwent total laryngectomy. Patients and methods Olfactory function assessment using the Scandinavian Odor Identification Test was carried out in 32 patients who had undergone total laryngectomy and were being followed up in Kasr El Aini ENT Outpatient Clinic. Results The studied cases included both men (59%) and women (41%). Their ages ranged from 50 to 70 years. The duration between operation and olfactory assessment ranged from 4.5 to 15.5 months. Results showed 75% incidence for anosmia and 25% incidence for hyposmia. Both age and sex did not correlate with either pattern of olfactory loss. The mean duration between operation and olfactory assessment was statistically significantly different between those who developed hyposmia and those who developed anosmia, being longer in the latter group. There was also a linear relation between the number of odors that could be smelled and postoperative duration. The longer the duration, the fewer the number of odors that could be smelled. The study reviewed similar studies and discussed suggested explanations. Conclusion The study also recommended preoperative olfactory assessment as well as postoperative olfactory rehabilitation for such patients.

Surgical Anatomy in Transoral Robotic Procedure: Basic Fundamentals

Transoral robotic surgery has proven to be an effective option for the management of different lesions involving several sub-sites of the head and neck, with the oropharynx the most commonly addressed one. Anatomical knowledge has been always and it is still now the fundamental premise to safely perform surgery. In transoral robotic procedures, historical external landmarks have less importance and “new” ones need to be outlined. In this chapter we have tried to offer a step-by-step logical approach to the surgical anatomy of the oropharynx and the supraglottic larynx focusing on the transoral perspective.

Ocular motor tests in relapsing remitting multiple sclerosis

Background Multiple sclerosis (MS) is the quintessential neurologic disorder from which one can gain insights into the principles of afferent and efferent neuro-ophthalmology. The popularity of eye movements as an experimental tool can be partly attributed to the fact that they can be conveniently and accurately measured and analyzed, and also because much is known about their neural substrate. It is therefore no surprise that eye movements have been commonly applied to better understand the visual and motor disorders in patients with MS. Objectives The aim of this study was to demonstrate the vast ocular motor abnormalities that occur in this disease using videonystagmography as our tool of description and determine the relationship with Expanded Disability Status Scale (EDSS) and MRI findings. Materials and methods The current study included 76 patients who were divided into two groups. Group I comprised 54 patients with relapsing-remitting multiple sclerosis who fulfilled the Revised Mcdonald′s criteria for diagnosis of MS. The age of the patients in group I ranged from 20 to 68 years, with a mean of 35.13 ± 9.42 SD (23 men and 31 women). Group II comprised 22 healthy age-matched and sex-matched individuals who were recruited from the general population and were not relatives of the patients. Their ages ranged from 19 to 54 years, with a mean of 33.81 years ± 10.07 SD (11 men and 11 women). Video-nystagmography, saccadic tracking, random horizontal saccades, optokinetic tracking (at 20, 40, and 60΀/s), smooth pursuit (0.2, 0.3, 0.4, 0.5, 0.6, and 0.7 Hz), and gaze-evoked nystagmus were examined in both groups. Group I, in addition, was subjected to a thorough neurological history and neurological examination, EDSS assessment, ophthalmologic examination (visual acuity and ocular motility), and radiological assessment by MRI with and without contrast. Results The eye movement disorders most commonly noted are saccadic dysmetria, followed by gaze-evoked nystagmus and pendular nystagmus. They are caused by disease affecting the brain stem and cerebellar circuits. Reduced pursuit gain and saccadic pursuit were also noted. A strong correlation between brainstem and cerebellar MRI lesions and the affection of the ocular motor system was well noted. A high EDSS score was well correlated with abnormal ocular motor test findings. Conclusion Ocular motor system tests are more sensitive than conventional clinical examinations in identifying abnormalities in MS.

Affection of the middle ear after radiotherapy for head and neck tumors

Aim The aim of this study is to evaluate the effect of radiotherapy (RT) as one of the modalities of treatment in patients with head and neck tumors on the Eustachian tube and middle ear. Study design This is a prospective study. Material and methods This study included 20 patients suffering from squamous cell carcinoma of the head and neck other than nasopharynx and parotid. They were treated either by surgery and postoperative radiotherapy or by primary radiotherapy alone or by concomitant chemoradiotherapy. Audiological evaluation was performed both pre-treatment and post- treatment in the form of pure tone threshold audiometry (PTA), tympanometry, stapedius acoustic reflex and eustachian tube (ET) function test. Results The 20 patients corresponded to 40 ears which were analyzed. Post RT tympanometry done revealed 16 (40%) ears with normal type A tympanogram and 24 (60%) ears with abnormal tympanometry findings, Post RT ET function test done revealed 7 (17.5%) ears with good ET function and 33 (82.5%) with abnormal ET function, acoustic reflex done post RT revealed 36 (90%) ears with absent acoustic reflex bilaterally and 4 (10%) ears with preserved acoustic reflex and Post RT PTA done revealed 16 (40%) ears with normal PTA, 13 (32.5%) ears with conductive hearing loss (CHL), 8 (20%) ears with sensori neural hearing loss (SNHL) and 3 (7.5%) ears with mixed hearing loss. Conclusion Patients with head and neck tumors given RT as one of the modalities of treatment have a high incidence of affection of middle ear function and ET dysfunction as well as development of CHL.