A Colossal Rhinolith

Introduction Rhinolith is a calcic deposition formed by mineralization of salts in an impacted nasal foreign body. It is a benign condition that can be troublesome owing to its size and extent of impact. Case Report A 35-year-old man with a history of right nasal obstruction with occasional foul-smelling discharge and right eye pain since ten years was diagnosed with rhinolith. During its removal, it was three times bigger than what could be visualized in nasal endoscopy. Conclusion Proper history, examination, and a high suspicion can clinch the diagnosis in almost all cases. A rigid diagnostic nasendoscopy is an important tool in the diagnosis. The treatment of choice is endoscopic removal under local or general anaesthesia

Venous Ectasia of Retromandibular and Common Facial Veins: A Rare Clinical Entity

Venous ectasias are benign conditions of the neck, in which focal dilatations of veins occur. Internal jugular, external jugular or superficial veins are usually the affected ones in the neck. They are often ignored or misdiagnosed. Here we are reporting a patient with venous ectasia of the retromandibular vein and the common facial vein. A 25-year-old male presented to our out-patient department with an intermittent swelling over the right side of the neck that he had for one year. The swelling was more prominent on lying down and on Valsalva maneuver. Radiologic imaging was suggestive of venous ectasia of the retromandibular vein and the common facial vein. Surgical excision was done for aesthetic reasons and in fear of thrombosis. Intraoperatively, we noticed that it was arising from the retromandibular and the common facial veins. Venous ectasias of superficial veins are rare. We can consider these patients for surgical excision in view of the risk of thrombosis, thromboembolic events, rupture, and aesthetic reasons

A case of chronic granulomatous craniofacial osteomyelitis

We present the clinical image of a 56-year old male who presented with chronic multiple craniofacial discharging sinuses with lytic, sclerotic destruction of facial bones on radiology causing gross facial deformity. He remained undiagnosed for years. The diagnosis was clinched on histopathology as a chronic granulomatous osteomyelitis showing Actinomyces. Keywords: Craniofacial, Granulomatous, Osteomyelitis, Actinomycosi

External Jugular Vein Aneurysm with Thrombus Presenting as Painful Neck Mass: A Case Report

Abstract External jugular vein aneurysm with thrombosis presenting as neck swelling is a rare clinical entity and rarely encountered in routine clinical practice. We present a case of a 45-year-old female with external jugular vein aneurysm presenting as a painful lump in the neck. Ultrasound of the neck and CT angiography showed saccular dilation of the lower end of the external jugular vein with thrombosis within the aneurysm. Saccular aneurysm of the external jugular vein is very uncommon and can lead to thrombotic complications with serious consequence

Cervical Thymic Cyst with parathyroid tissue – a diagnostic conundrum

Cervical thymic cysts are relatively rare benign cystic lesions that tend to be diagnosed clinically as branchial cysts, which usually present as painless, enlarging neck masses. They can occur anywhere along the normal path of descent of thymic primordia from the angle of the mandible to the sternal notch, with mediastinal extension observed in approximately 50% of cases. They are usually seen in the first decade of life on the left side with a male predominance. Here we report a case of a 15-year-old boy who presented to the hospital with left-sided neck swelling for about 2 months. The neck’s contrast-enhanced computed tomography (CECT) revealed a large, well-defined cystic swelling in the left neck region, showing peripheral enhancement, seen from the submandibular region to the superior mediastinum extending into the retrosternal region. Direct fine needle aspiration (FNA) was done, which showed a benign lesion with inflammatory and cystic characteristics, leading to the possibility of a branchial cyst. The cyst was completely excised surgically. Histopathology showed a thymic cyst with parathyroid tissue. The presence of thymic tissue with Hassall’s corpuscles is essential for the diagnosis. Knowledge of the clinical presentation, cyto-histological findings, and differential diagnosis of cystic cervical lesions in the pediatric population is important to diagnose this rare entity. Hence, though uncommon, when one comes across a cystic cervical region mass in children, a diagnosis of cervical thymic cyst should be kept in mind. Nonetheless, a definitive diagnosis depends on imaging findings as well as intraoperative findings and histopathological examination

Chronic Candida osteomyelitis of hard palate and nose: A diagnostic quandary

Candida induced osteomyelitis is infrequent. There is scarcity of literature on this entity in maxillofacial region and thus there is possibility to mismanage such cases. We are presenting a case of chronic maxillofacial Candida tropicalis osteomyelitis causing palatal and septal perforation with saddle nose deformity in a young lady with commencement and progression of disease process over two pregnancies. Diagnosis was established by histopathology and repeated isolation on culture. Debridement followed by adequate antifungal therapy instituted. Keywords: Candida, Osteomyelitis, Pregnancy, Maxillofacial, Hard palat

Subglottic hemangioma masquerading as croup and treated successfully with oral propranolol

Subglottic hemangioma (SGH) is a rare and potentially life-threatening condition of the airway. A 3-month-old girl presented with croup which improved only partially with nebulized adrenaline and intramuscular dexamethasone. An upper airway endoscopy revealed the diagnosed of SGH. Oral propranolol was started, and following that, there was a dramatic response within 48-h of therapy, and complete remission after 1 year of therapy

Effect of cataract surgery on the corneal endothelium: modern phacoemulsification compared with extracapsular cataract surgery.

PURPOSE: To investigate whether modern phacoemulsification surgery results in more damage to the corneal endothelium than extracapsular cataract extraction (ECCE), and to examine which preoperative, operative, and postoperative factors influence the effect of cataract surgery on the endothelium. DESIGN: Randomized controlled trial. PARTICIPANTS: Five hundred patients 40 years or older were randomized into 2 groups (ECCE, 249; phacoemulsification, 251). METHODS: Central corneal endothelial cell counts, coefficient of variation of cell size, and hexagonality were assessed before surgery and up to 1 year postoperatively. MAIN OUTCOME MEASURE: Endothelial cell count. RESULTS: Four hundred thirty-three patients completed the trial. The initial preoperative mean cell count for the entire sample was 2481 (standard error [SE]: 18.6), reduced at 1 year postoperatively to 2239 (SE: 23.5). An average 10% reduction in cell count was recorded by 1 year postoperatively. There was no such change in hexagonality or in the coefficient of variation. There was no significant difference in overall percentage cell loss between the 2 treatment groups. Factors associated with excessive cell loss (> or =15% by 1 year) were a hard cataract (odds ratio [OR]: 2.1, 95% confidence limits: 1.1-4.1; P = 0.036), age (OR: 1.04, P = 0.005), and capsule or vitreous loss at surgery (OR: 2.38, P = 0.106). Phacoemulsification carried a significantly higher risk (OR: 3.7, P = 0.045) of severe cell loss in the 45 patients with hard cataracts relative to ECCE (52.6% vs. 23.1%; chi-square test, P = 0.041), with both procedures achieving similar postoperative visual acuity outcomes. CONCLUSIONS: No significant difference in overall corneal endothelial cell loss was found between these 2 operative techniques. The increased risk of severe cell loss with phacoemulsification in patients with hard cataracts suggests that phacoemulsification may not be the optimal procedure in these cases, and that ECCE should be preferred

Urban Evolution: The Role of Water

The structure, function, and services of urban ecosystems evolve over time scales from seconds to centuries as Earth’s population grows, infrastructure ages, and sociopolitical values alter them. In order to systematically study changes over time, the concept of “urban evolution” was proposed. It allows urban planning, management, and restoration to move beyond reactive management to predictive management based on past observations of consistent patterns. Here, we define and review a glossary of core concepts for studying urban evolution, which includes the mechanisms of urban selective pressure and urban adaptation. Urban selective pressure is an environmental or societal driver contributing to urban adaptation. Urban adaptation is the sequential process by which an urban structure, function, or services becomes more fitted to its changing environment or human choices. The role of water is vital to driving urban evolution as demonstrated by historical changes in drainage, sewage flows, hydrologic pulses, and long-term chemistry. In the current paper, we show how hydrologic traits evolve across successive generations of urban ecosystems via shifts in selective pressures and adaptations over time. We explore multiple empirical examples including evolving: (1) urban drainage from stream burial to stormwater management; (2) sewage flows and water quality in response to wastewater treatment; (3) amplification of hydrologic pulses due to the interaction between urbanization and climate variability; and (4) salinization and alkalinization of fresh water due to human inputs and accelerated weathering. Finally, we propose a new conceptual model for the evolution of urban waters from the Industrial Revolution to the present day based on empirical trends and historical information. Ultimately, we propose that water itself is a critical driver of urban evolution that forces urban adaptation, which transforms the structure, function, and services of urban landscapes, waterways, and civilizations over time