Orbital Complications of Rhinosinusitis

Background: Suppurative extension of rhinosinusitis to the orbit is acomplication that often results from delay in diagnosis and, or inadequatetreatment. These complications may range from preseptal cellulitis, orbitalcellulitis, orbital abscesses, and subperiosteal abscesses to intracranial extension with a threat to both vision and life. This study aims to review the clinical profile, treatment modalities and outcome of orbital complications of rhinosinusitis in Ibadan, Nigeria.Method: A retrospective review of the charts of patients with orbital complications of rhinosinusitis managed in the departments of Otorhinolaryngology and Ophthalmology, University College Hospital, Ibadan over a five year period (Feb 2002- Jan 2007) was carried out .The diagnosis of rhinosinusitis was based on history, physical examination, plain x ray and CT scan findings and antral puncture. Demographic data, clinical presentation and treatment were evaluated.Results: A total of 24 patients were reviewed in the study. There were 13males and 11females (M/F, 1:1). The age range was 8months to 75years, 14 (58.3%) patients were children and while 10 (41.7%) patients were adults. 75% of the patients were seen during the dry season (November to February). The duration of symptoms ranged from one day to three weeks. Involvement of one eye occurred in 14 patients (58.3%); right eye (4), left eye (10). Both eyes were involved in 10 patients (41.7%). Non-axial proptosis was seen in 8 patients (33.3%). It was infero-lateral in 6 patients (25%) and infero-nasal in two (8.3%) patients.  Orbitalcellulitis was seen in 10 (41.7%) patients, 6 (25%) patients had preseptal cellulitis while 8 (33%) patients had orbital abscess. Cavernous sinus thrombosis was seen in 3 (12.5%) patients. The cases with preseptal and orbital cellulitis were effectively managed by intravenous antibiotics. Orbital abscesses were drained surgically with complete resolution. Sinus surgical procedures were done in 10(41.7%) patients. This group of patients had preoperative visual acuity of between 6/6 and 6/60. They all had complete resolution of proptosis and good visual outcome.Conclusion: Orbital complications of acute rhinosinusitis are common inchildren. Surgical drainage and aggressive medical management remain the standard to achieve a good prognosis and visual outcome

Pattern of Ophthalmic Consult from the Ear, Nose and Throat Ward of a Tertiary Hospital

Objective: To study the pattern and indications for ophthalmicreferral of patients with otorhinolaryngology problems.Method: A retrospective study of patients who were admittedinto the Ear, Nose and Throat (ENT) ward of the UniversityCollege Hospital, Ibadan and had ophthalmic referral betweenJuly 2000 and June 2004. The parameters evaluated were thedemography of the patient, indication for ophthalmic consult,and the contribution of the ophthalmologist towards themanagement of the patient.Results: Reports on 26 patients on whom ophthalmic consultswere sent were available for review. This accounted for 3%of the patients admitted during the period under review.Fourteen (53.8% ) of the consults were sent on account ofproptosis and 7 (26.9%) for complaints of poor vision. In 12(46.2%) of these patients, the otorhinolaryngologicaldiagnosis was sinonasal tumour. The ophthalmologist madepositive contributions to the management of 20 (76.9%) ofthe patients. These included the use of lubricants/protectiveshield (6 [23.1%]), tarsorrhaphy (3 [ 11.5%]), antiglaucomamedication (2[7.7%]) and cataract extraction (2[7.7%]).Conclusion: Proptosis ranked highest for ophthalmic consultfrom the ENT ward in this review. Close collaborationbetween subspecialties should be encouraged when managingvisually-threatening conditions. There is also the need for astandard referral protocol

Heavy metals contamination of Chrysichthys nigrodigitatus and Lates niloticus in Ikere Gorge, Oyo state, Nigeria

This study investigates the presence of heavy metal contamination of Chrysichthys nigrodigitatus and Lates niloticus. Adult C. nigrodigitatus and L. niloticus were obtained from fishermen in Ikere Gorge, Oyo state, Nigeria. Water samples were also collected during the wet and dry seasons of the year in the same locality. The presence of five metals were analyzed in both fish and water. Iron, copper, zinc, lead and manganese were investigated by atomic absorption spectrosocopy (AAS) in two separate experiments. In each case, four tissues; gills, bone, intestine and muscle were compared with the level of metals in the water. Lower concentrations of metals were recorded in water than in fish. Lower concentration of the metals found in fish and water was less than that recommended by the World Health Organisation (WHO) guideline for maximum concentration recorded in the tissue of the two samples. Iron was found to be dominant in the intestine of C. nigrodigitatus, while manganese was found to be highest in the bone of L. niloticus, copper recorded the least of all the metals. There is significant difference (P < 0.05) in heavy metals concentration in the gill of C. niloticus and water, as well as the concentration in the intestine of L. niloticus and water. It was concluded that though the heavy metals of interest were present in measurable quantities, they were still within safe limits for consumption.Key words: Heavy metals, fish, gorge, contamination

Congenital bilateral fusion of the maxillomandibular alveolar processes with craniosynostosis: report ofa rare case

A rare congenital anomaly of maxillomandibular fusion with pectus excavatum and craniosynostosis in a neonate is presented. The child was kept alive by nasogastric tube feeding.Amodification of classification of syngnathia is proposed. The aetiopathogenesis and difficulty in management in our environment are discussed. Keywords: Bilateral; alveolar fusion; craniosynostosis; pectus excavatum Nigerian Journal of Clinical Practice Vol. 11 (1) 2008: pp.78-8

African oral histoplasmosis mimicking lip carcinoma: case report

A case of Iocalised African histoplasmosis with an unusual presentation in a 56 year old Nigerian farmer is reported. The lesion presented as an ulcer clinically mimicking squamous cell carcinoma of the lower lip. An incisional biopsy and culture studies confirmed African histoplasmosis and the utcer healed spontaneously without treatment. This case is reported to highlight the unusual location and clinical course of African histoplasmosis

A C T 91 Intraoral penetrating injury from a long metallic foreign body: a case report

Children often play with sharp objects in their mouths without knowing the injurious effects of such action. These objects can accidentally cause severe injury to oro-pharyngeal tissues. Timely removal of such objects is essential to prevent life threatening complications. This paper presents a case of an intraoral penetrating injury in a 5 year old patient caused by a long metallic foreign object. The foreign body was successfully removed by meticulous exploration through the existing wound. Educational measures such as enlightening the parents and guardians on the importance of keeping dangerous materials from the reach of their children may be necessary. The need to immediately bring such patients to the hospital for expert management in case of inadvertent injury and also to comply with follow-up appointments is also essential.Key words: Intra –oral penetrating injury; foreign object; lateral pharyngeal space

Median cleft of the upper lip: report of cases

Background: Median cleft of upper lip is an uncommon facial anomaly and the severe form of it rarely survives infancy because of the associated brain tissue (corpus callosum agenesis) deformity. Surgical correction can be challenging especially when it is associated with premaxilla agenesis and absence of columella and nasal septum.Materials/Method: A review of presentation and management of five patients with median cleft of upper lip and the discussion of relevant literature.Result: Four of the cases were adult. Repair of defects were carried out by Burrow’s procedure, inverted V excision technique combined with sub-periosteal undermining at labio-buccal sulci. Effective mobilization of labial flaps on both sides ensured good apposition, but the absence of columella and nasal septum remains a major challenge in reconstruction of the defect.Conclusion: Late presentation, attributed to ignorance and poverty remains a concern in management; apart from ignorance and poverty, shortage of specialists and facilities for craniofacial surgery in Northern Nigeria may also contribute to their late presentation. Multiple surgical interventions are also not usually attractive to the patients hence result of repair are modest

Cleft lip and palate surgery in children: Anaesthetic considerations

Background: The Care of cleft patients is very challenging. Team cleft care is usually lacking in many developing countries due to shortage of qualified manpower. This study is aimed at highlighting anaestheticchallenges in the management of cleft in children.Patients and Methods: This was a study of cleft lip and palate patients who were managed during team cleft care activities at University of Maiduguri Teaching Hospital and Federal Medical Centre Nguru both in northeastern Nigeria from January to June 2009.Results: One hundred and six cleft patients presented for surgicalrepair under general or local anaesthesia. Fifteen (14%) patients all of whom children were unfit for general anaesthesia due to various medical reasons. Ninetyone (86%) cleft patients comprising 53(50%) childrenand 38(36%) adults had cleft repair under halothane general endotracheal anaesthesia and local anaesthesia, respectively. There was no anaesthetic complications recorded under local anaesthesia. Fifteen percent ofchildren who received general endotracheal anaesthesia suffered various anaesthetic complications which included hypoxia (3.8%), laryngospasm (1.9%), kinking of endotracheal tube (5.7%), inadvertent extubation(1.9%) and pulmonary aspiration (1.9%). There was no mortality or anaesthesia-related morbidity at the time of discharge in all the cases. Conclusion: We conclude that anaesthesia for cleft lip and palate repair in hospital based team-cleft care activities in our environment is relatively safe. We recommend general anaesthesia with controlled ventilation for children and local anaesthesia for adult and older children who can cooperate

Nigerian mistletoe (Loranthus micranthusLinn) aqueous leaves extract modulates some cardiovascular disease risk factors in monosodium glutamate induced metabolic dysfunction

The safety of monosodium glutamates (MSG's) usage has generated much controversy locally and globally. This study investigates the efficacy of Loranthus micranthus in modulating the metabolic disorder associated with MSG intake. Thirty five (35) female rats randomized to three groups labeled 1 (7 rats), 2 (21 rats) and 3 (7 rats), respectively were used. They were administered with normal saline, MSG (200 mg/Kg) and MSG (200 mg/kg) + L. micranthus (600 mg/Kg), respectively for 28 days. Seven rats were then sacrificed from each group. The remaining rats in group 2 were then redistributed to groups labeled 4 and 5 consisting of 7 rats each. MSG was then withdrawn from all the rats. Group 4 was treated with L. Micranthus (600 mg/Kg) while normal saline was administered to group 5. All administrations were carried out for 30 days. The rats were then sacrificed and the serum was used for analysis. Analysis showed increase total cholesterol, triglyceride, low-density lipoprotein (LDL) -cholesterol, glucose and total protein concentrations and a reduced high-density lipoprotein (HDL) -cholesterol (when MSG was administered). These parameters were restored to normal with L. micranthus treatment. Although no histological change was observed in the uterus, there was a significant increase in organs relative weight when rats were placed on MSG but this was reversed with L. micranthus. The study suggests the efficacy of L. micranthus in reversing cardiovascular disorder and its ability to prevent MSG induced fibroid in rat.Keywords: Cardiovascular diseases, cholesterol, Lipid profile, Loranthus micranthus, of monosodium glutamates (MSG).African Journal of Biotechnology, Vol 13(39) 3989-399

Bacteriological analysis of spent engine oil contaminated soil planted with cowpea (Vigna unguiculata)

The bacteriological analysis of soil contaminated with spent engine oil (SEO) planted with cowpea was investigated. The aim of this study was to detect the microbial degradation of SEO in soil and how it affects the microbial activity and the effects of SEO on the growth of cowpea. SEO collected from a mechanic workshop in Ilorin was introduced into soil in varying concentrations. The experimental set up was in triplicates with six treatments of SEO. Soil samples were taken every week for the duration of six weeks for laboratory analysis. Plant growth parameters were measured every week after planting. The pH of the soil and the bacterial population of the soil were also observed. Findings revealed that the plant growth parameters were significantly reduced as the concentration of SEO increased in the soil. Bacterial counts were also determined and a total of six bacterial species were isolated from the soil samples. Bacillus subtilis, Micrococcus luteus, Pseudomonas aeruginosa and Pseudomonas putida occurred in the control and contaminated soil samples. Bacterial counts ranged from 1.89×105 to 4.25×105 cfu/ml in the soil samples with the highest occurring in the control and the least occurring in 224ml of SEO. SEO contaminated soil has adverse effect on cowpea and on bacterial flora of the soil. The results of this study revealed that Pseudomonas aeruginosa, Micrococcus luteus and Bacillus subtilis can utilize SEO in the soil. They could be harnessed for use in bioremediation of soil polluted with petroleum and petroleum products.Key Words: Bacteria, Spent engine oil, Soil, Cowpe