Bilateral Schwartze Sign, Decision-Making for Surgery

Otosclerosis is an otic capsule disorder that leads to progressive conductive and/or sensorineural hearing loss due to stapes footplate fixation and cochlear bone involvement. The disorder is bilateral in 70% of patients and it usually starts between the third and fifth decade. One of its characteristic clinical findings is Schwartze sign which refers to a reddish discoloration over the promontory seen beyond the intact tympanic membrane. Schwartze sign, also known as Flemingo's flush sign or Rising sun sign is believed to be associated with otospongiosis which is the active phase of the disease. The prevalence of Schwartze sign is estimated to be 10%. The prevalence of bilateral sign has not been reported, but it is presumed to be too low. Herein, we introduce a patient with bilateral positive Schwartze sign. A twenty two year old woman with bilateral hearing loss came to our clinic. She also complained from non pulsating tinnitus in both ears since one year ago. On physical examination, bilateral schwartze sign with an intact tympanic membrane was noted (Fig.1).  The audiometric evaluation showed a conductive hearing loss with speech reception threshold of 50 dB and 30 dB for the right and left ear respectively. Sodium fluoride 8mg every 8 hours was prescribed for three months. She noticed partial improvement during the treatment and on her otoscopic exam, the Schwartze sign was reduced. Then stapedotomy was scheduled for the right ear (the worse ear in regard to     the hearing & tinnitus). The surgery went uneventful and she proved to be much better afterwards. Her right ear tinnistus has gone completely and the speech reception threshold has changed from 45 dB preoperatively to 10 dB postoperatively. It seems that the surgery remains a therapeutic option, when the active phase of the disease is stabilized even following a short course of pharmacologic therapy

Placenta accreta spectrum disorders - detection rate and maternal outcomes following implementation of an institutional protocol.

Placenta accreta spectrum (PAS) disorders have been on the rise in recent years with increasing caesarean rates. The purpose of this prospective observational study was to describe our detection rates and to review outcomes in PAS after the introduction of an institutional screening and management protocol. Twenty-one patients with suspected PAS over 5 years were identified. 20/21 patients had an accurate determination of placental invasion and positive correlation with surgical and histopathological examination. Early morbidity (massive haemorrhage) was found in 7/21 patients, whilst late morbidity (hospital readmission) was found in 5/21 patients. There were no maternal deaths and admissions to intensive therapy unit (ITU). In summary, our centre demonstrated a high antenatal detection rate for PAS using an evidence-based protocol. This has led to timely intervention by an experienced multidisciplinary team and excellent outcomes. Immediate and delayed postoperative counselling was effective for optimal patient understanding and experience.Impact Statement With rising caesarean section rates, the incidence of placenta accreta spectrum (PAS) disorders is increasing. Despite this, most obstetricians have personally managed only a small number of patients with PAS. Moreover, there appears to be some debate over the optimal diagnostic and management strategy. As the incidence increases, development of institutional screening and management protocol is a necessity for large units. Timely diagnosis, extensive pre and postoperative counselling and multidisciplinary teamwork ensure reduced early and late morbidity. Evidence based screening protocols for PAS disorders reduce the likelihood of undiagnosed cases and should be developed in every unit. Consideration must also be given to standardisation of the diagnostic and management protocols, including contingency plan for emergencies

Nodular Fasciitis of the Auricle: A Case Report

Introduction: Nodular fasciitis is described as a benign reactive proliferation of myofibroblasts. Due to its rapid-growing nature, a precise clinical diagnosis is difficult and the condition is frequently misdiagnosed as malignant lesions.   Case Report: In this study, we present the case of a young woman with an auricular nodular fasciitis as an example of one of the rarest sites of this tumor. The patient underwent an excision of the lesion under general anesthesia. The literature choices for treatment include complete excision, partial excision, or intralesional injection of steroids. Due to its associated local discomfort, and in order to exclude other differential diagnosis, we recommend a complete surgical excision.   Conclusion:  Auricular nodular fasciitis is a rare lesion. Due to its associated local discomfort, and in order to exclude other differential diagnosis, we recommend a complete surgical excision

Reconstruction of Buccal Mucosa, Upper and Lower Lip Defect Using Free Radial Forearm Flap with Palmaris Longus Tendon: A Case Presentation

Introduction: Advanced lip carcinomas can invade adjacent structures. Performing surgery for these cancers will lead to defects in this anatomically and functionally important area and will cause post-op difficulties such as drooling, speech alterations and aesthetic considerations, if not properly managed. Case Report: In this study, we will introduce a radial forearm free flap with palmaris longus tendon to reconstruct a defect of a large lower lip carcinoma. Our patients was a male in the 7th decade of life with an advanced lower lip carcinoma invading the full thickness of the buccal mucosa, left commissure and the left third of the upper lip. Resection was performed with adequate margins; checked by frozen sections and radical modified neck dissection was also performed on the left side. Free radial forearm flap with palmaris longus tendon was harvested and anastomosed in the neck. Four months after surgery commissurroplasty was done and the flap volume reduced Conclusion: The radial forearm free flap with palmaris longus tendon provides a good functional lip with a reasonable aesthetics in our patient. The patient was satisfied with the result and there were no functional complaints such as drooling reported by him. We think that this flap could be a flap of choice for reconstruction of the large, full thickness lip defects

Spontaneous Endometriosis of the Abdominal Wall

Abdominal wall endometriosis, the commonest type of extra-pelvic endometriosis, may rarely develop spontaneously in the absence of prior surgical scar. We aim to report 3 cases with this unique characteristic, two of them with a diagnosis of unusual development of umbilical endometriosis and one with inguinal endometriosis, from the perspective of a general surgeon. Because of the potential pitfalls in its diagnosis, endometriosis should be emphasized in the differential diagnosis of abdominal wall masses

An Unusual Cause of Dysphonia with Hemoptysis: A Laryngeal Live Leech

Introduction: Foreign bodies in the upper airway are one of the most challenging otolaryngology emergencies and have various presentations depending on their physical properties and location. Leeches are blood-sucking hermaphroditic worms that vary in color, length, and shape. They usually reside in fresh-water streams and lakes. When rural untreated water is drunk, leeches may localize in the nose, pharynx, and esophagus, or rarely in the larynx. Case Report: This case is a man who was referred to our otolaryngology clinic with a complaint of hemoptysis and mild respiratory distress. The patient’s symptoms were all relieved post operatively and he was discharged on the second day following the procedure.  Conclusion: Leeches should be suspected as an airway foreign body in patients with a recent history of drinking stream water

Repair of traumatic post-coital recto-vaginal fistula - Video Vignette.

A 19- year-old female presented with vaginal bleeding after consensual sexual intercourse. Initial examination was unremarkable and she was reassured. Six days later, she re-presented passing faeces and flatus per vaginum. On examination, there was a 30 x 20 mm suprasphincteric recto-vaginal fistula (RVF), with no evidence of peritonitis or sepsis. She underwent an uneventful emergency laparoscopic defunctioning colostomy. This article is protected by copyright. All rights reserved

Evaluation of Lateral Crura Divergence Angle of Iranian Candidates for Primary Rhinoplasty

BACKGROUND Cephalic malposition of the lower lateral cartilages is a common nasal anatomic variation. Knowing the range of lateral crura (LC) divergence angle in Iranian population can help Middle East plastic surgeons. This study aimed to determine LC divergence angle of candidates for primary rhinoplasty in Iranian population. METHODS This cross-sectional study was conducted on 256 candidates for primary rhinoplasty from November 2017 through May 2018. Two sides of LC divergence angle were measured intraoperatively by a researcher-made device. RESULTS Totally, 211 female and 45 male patients with the mean age of 29.9 +/- 6.51 years were recruited. The mean LC divergence angle was 35.86 +/- 4.74 degrees (between 20-50 degrees). The mean LC divergence angle was 35.11 degrees and 36.02 degrees in male and females, respectively. There was no significant difference between males and females. In addition, there was no significant correlation between LC divergence angle and age. LC divergence angle had normal distribution and about 68% of the LC divergence angle were within one standard deviation of the mean (i.e. 32 to 40 degree). CONCLUSION In 16% of studied people, the divergence angle of the lateral crus of the lower lateral cartilage was lower than 32 degrees and was considered as malposition

VATER/VACTERL syndrome (vertebra/anus/cardiac/trachea/esophogus/radius/renal/limb anomalies) with a noncommunicating functioning uterine horn and a unicornuate uterus: a case report.

OBJECTIVE To describe the presentation and outcome of a patient with an unusual association of VATER/VACTERL syndrome (vertebra/anus/cardiac/trachea/esophogus/radius/renal/limb) and noncommunicating functioning uterine horn and a unicornuate uterus. DESIGN Descriptive case report. SETTING A foundation trust in the United Kingdom. MATERIALS AND METHOD(S): A patient known to have VATER/VACTERL syndrome was diagnosed with a hematometra of a noncommunicating uterine horn and hematosalpinx. She underwent multidisciplinary surgery to remove the functioning uterine horn, after which she had a full recovery. CONCLUSION(S) This case documents the association of VATER/VACTERL syndrome with a unicornuate uterus and noncommunicating horn