Does Timing of Diagnosis and Management of Iatrogenic Ureter Injuries Affect Outcomes? Experience From a Tertiary Center

BACKGROUND: Mucocele is a true cystic expansile mass filled with mucus resulting from obstruction of the sinus ostia. Prompt diagnosis and management are needed to avoid complications due to the intracranial or intra-orbital extension. OBJECTIVES: To audit data of mucocele of the paranasal sinuses in a tertiary center, to review the literature regarding the clinical features and the management of mucocele in the paranasal sinus and to emphasize the iatrogenic causes of mucocele after the development of Endoscopic Skull Base Surgeries. MATERIALS AND METHODS: A retrospective analysis of etiology, clinical presentation, sinuses involved, operative technique, complication, recurrence were interpreted. RESULTS: The mean age of 16 patients managed is 49. Location:37% frontal,19% ethmoidal,19% frontoethmoidal,19% sphenoidal,6% maxillary. The iatrogenic cause was 44%. Symptoms included proptosis, external swelling, nasal block, and discharge, and vision loss. Complications were orbital abscess and skull base defect. 14 patients underwent endoscopic procedures-excision or marsupialization. One patient underwent craniotomy; one patient combined approach was performed. One patient had a recurrence. CONCLUSION: Mucocele of the paranasal sinuses is still a rare clinical scenario and it is imperative to note that any delay in diagnosis and management can lead to expansion and erosion of the bony wall of the sinuses and causing complications.

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Disorders of sex development: timing of diagnosis and management in a single large tertiary center

Endocrine Connections ◽

10.1530/ec-18-0070 ◽

2018 ◽

Vol 7 (4) ◽

pp. 595-603 ◽

Cited By ~ 4

Author(s):

E Kohva ◽

P J Miettinen ◽

S Taskinen ◽

M Hero ◽

A Tarkkanen ◽

...

Keyword(s):

Turner Syndrome ◽

Klinefelter Syndrome ◽

Molecular Genetic ◽

Genetic Diagnosis ◽

Disorders Of Sex Development ◽

Survey Period ◽

Temporal Shift ◽

Diagnosis And Management ◽

Bilateral Cryptorchidism ◽

Tertiary Center

Background We describe the phenotypic spectrum and timing of diagnosis and management in a large series of patients with disorders of sexual development (DSD) treated in a single pediatric tertiary center. Methods DSD patients who had visited our tertiary center during the survey period (between 2004 and 2014) were identified based on an ICD-10 inquiry, and their phenotypic and molecular genetic findings were recorded from patient charts. Results Among the 550 DSD patients, 53.3% had 46,XY DSD; 37.1% had sex chromosome DSD and 9.6% had 46,XX DSD. The most common diagnoses were Turner syndrome (19.8%, diagnosed at the mean age of 4.7 ± 5.5 years), Klinefelter syndrome (14.5%, 6.8 ± 6.2 years) and bilateral cryptorchidism (23.1%). Very few patients with 46,XY DSD (7%) or 46,XX DSD (21%) had molecular genetic diagnosis. The yearly rate of DSD diagnoses remained stable over the survey period. After the release of the Nordic consensus on the management of undescended testes, the age at surgery for bilateral cryptorchidism declined significantly (P < 0.001). Conclusions Our results show that (i) Turner syndrome and Klinefelter syndrome, the most frequent single DSD diagnoses, are still diagnosed relatively late; (ii) a temporal shift was observed in the management of bilateral cryptorchidism, which may favorably influence patients’ adulthood semen quality and (iii) next-generation sequencing methods are not fully employed in the diagnostics of DSD patients.

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