An Osteoma of the Middle Ear Presenting with the Tullio Phenomenon

The Tullio phenomenon is an extremely rare condition in which loud noise induces a brisk vestibular response. Osteomas of the middle ear cleft are also uncommon. We report a patient with an osteoma of the middle ear cleft that became symptomatic with progressive facial palsy and mixed hearing loss. The onset was heralded by the Tullio phenomenon, which she had experienced for 10 years. The differential diagnosis of the Tullio phenomenon and the management of middle ear osteomas are discussed

Outcomes of infrapopliteal endoluminal intervention for transatlantic intersociety consensus C and D lesions in patients with critical limb ischaemia

Background: Recent data suggest that infrapopliteal percutaneous transluminal angioplasty (PTA) is a reasonable primary therapy for critical limb ischaemia (CLI). Based on the transatlantic intersociety consensus (TASC) classification, this has been found to be true for lesions classified as A, B or C. We report our experience with infrapopliteal PTA stratified by TASC classification. Methods: A retrospective study of patients who underwent infrapopliteal PTA with or without stenting from October 2007 to July 2011 was conducted, revealing 83 limbs. The primary outcome variables were freedom from reintervention and freedom from index limb amputation. Secondary outcomes were technical success, post-operative complications and survival. TASC classification was assessed for the individual vessel(s) chosen for intervention. Results: Median age was 76 years and radiological success was 86.75%. Average follow-up was 15 months. At 1 and 2 years, freedom from re-intervention, or amputation was 65.1% and 55.6%. Limb salvage was 77.7%. Within 2 years, 2% underwent bypass and 18% repeat infrapopliteal PTA. The 30-day mortality was 5%. Overall survival was 84.5%, 71.8% and 61.6% at 1, 2 and 3 years. Eighty-twopercent were classified as TASC D lesions. Radiological success was achieved in 100% of TASC C lesions in contrast to 86.7% of TASC D lesions. There was not a statistically significant relationship between primary outcomes and TASC D classification. Discussion: Given the encouragingly high rates of radiological success and limb salvage, an attempt at PTA is indicated as an alternative to primary amputation even in patients with radiologically demonstrated severe disease

Outcome of angioembolization for blunt renal trauma in haemodynamically unstable patients: 10-year analysis of Queensland public hospitals

Background: The aim of the study was to evaluate whether angioembolization is an appropriate alternative method for the management of blunt renal trauma in haemodynamically unstable patients. Methods: A retrospective analysis was conducted from 2002 to 2012 at three tertiary trauma hospitals in the state of Queensland. Patients who had blunt renal trauma and underwent renal angioembolization or had a trauma nephrectomy were identified using patient records and operating theatre and interventional radiology databases. The inclusion criteria were – haemodynamically unstable patients with blunt renal trauma treated with angioembolization, above the age of 16 years. Patients who underwent angioembolization for other causes such as: penetrating renal trauma, post-procedure, renal tumours, renal angiomyolipomas or arteriovenous malformations were excluded. Patients below the age of 16 were also excluded. Post-embolization renal function, blood pressure, morbidity and mortality were analysed using the paired t test. Results: A total of 668 renal trauma patients were identified during this period. Sixteen patients underwent angioembolization for blunt renal trauma. Post-procedure renal function normalized without any hypertension with the median follow up being 4 months. Four patients had post-embolization complications including a urinoma, two devascularized kidneys and one ureteric stricture requiring nephrectomy. There was no mortality. Conclusion: Selective angioembolization, where feasible, is an alternative method in the management of haemodynamically stable patients with blunt renal trauma maximizing nephron sparing and producing acceptable long-term outcomes with avoidance of the morbidity of trauma nephrectomy. This is the first study that we know of in Australia analysing the outcome of angioembolization for blunt renal trauma