1068 Cranial Fasciitis of the Temporal Bone

Abstract We present the case of a child with a rare benign tumour of the temporal bone. A nine-month-old girl was referred to her local paediatric hospital with a painless right-sided, post-auricular swelling increasing in size in the preceding two months. On examination there was a 2x2cm mass overlying the temporal bone posterior to the right ear. The mass was firm, immobile, non-tender and well circumscribed. Ultrasound demonstrated a 1.9cm subcuticular mass with evidence of intracranial extension through the suture. Vascular flow and hyperechoic foci were demonstrated within the lesion. The local paediatric team requested magnetic resonance imaging (MRI) and computed tomography (CT) of temporal bone prior to referral to tertiary care centre. Imaging displayed a 2cm expansile lesion of the temporal bone with cortical loss and effacement of underlying dural venous sinus. The patient proceeded to incisional biopsy for tissue diagnosis which was suggestive of cranial fasciitis. Following discussion at the regional multidisciplinary meeting, she underwent surgical excision of the tumour in a joint Neurosurgery/Otology case. The tumour was fully resected macroscopically, with the normal surrounding bone and mastoid air cells preserved. Final histopathology showed a highly cellular lesion composed of spindle cells arranged in fascicles, with areas of myxoid background and confirmed the tumour to be cranial fasciitis. The child has made a good recovery and will be kept under close clinical follow-up. This case demonstrates a rare benign tumour of the temporal bone that may present to an otolaryngologist and the importance of tissue diagnosis, imaging and multidisciplinary management.

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Time series evaluation of improvement interventions to reduce alarm notifications in a paediatric hospital

BMJ Quality & Safety ◽

10.1136/bmjqs-2019-010368 ◽

2020 ◽

Vol 29 (9) ◽

pp. 717-726 ◽

Cited By ~ 3

Author(s):

Colleen M Pater ◽

Tina K Sosa ◽

Jacquelyn Boyer ◽

Rhonda Cable ◽

Melinda Egan ◽

...

Keyword(s):

Patient Safety ◽

Improve Patient Safety ◽

Tertiary Care ◽

Secondary Outcome ◽

Secondary Outcome Measure ◽

Tertiary Care Centre ◽

Patient Acuity ◽

Nursing Satisfaction ◽

Paediatric Hospital ◽

Hospital Units

Background10The Joint Commission identified inpatient alarm reduction as an opportunity to improve patient safety; enhance patient, family and nursing satisfaction; and optimise workflow. We used quality improvement (QI) methods to safely decrease non-actionable alarm notifications to bedside providers.MethodsIn a paediatric tertiary care centre, we convened a multidisciplinary team to address alarm notifications in our acute care cardiology unit. Alarm notification was defined as any alert to bedside providers for each patient-triggered monitor alarm. Our aim was to decrease alarm notifications per monitored bed per day by 60%. Plan-Do-Study-Act testing cycles included updating notification technology, establishing alarm logic and modifying bedside workflow processes, including silencing the volume on all bedside monitors. Our secondary outcome measure was nursing satisfaction. Balancing safety measures included floor to intensive care unit transfers and patient acuity level.ResultsAt baseline, there was an average of 71 initial alarm notifications per monitored bed per day. Over a 3.5-year improvement period (2014–2017), the rate decreased by 68% to 22 initial alarm notifications per monitored bed per day. The proportion of initial to total alarm notifications remained stable, decreasing slightly from 51% to 40%. There was a significant improvement in subjective nursing satisfaction. At baseline, 32% of nurses agreed they were able to respond to alarms appropriately and quickly. Following interventions, agreement increased to 76% (p<0.001). We sustained these improvements over a year without a change in monitored balancing measures.ConclusionWe successfully reduced alarm notifications while preserving patient safety over a 4-year period in a complex paediatric patient population using technological advances and QI methodology. Continued efforts are needed to further optimise monitor use across paediatric hospital units.

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Radiological Assessment of the Indian Children with Congenital Sensorineural Hearing Loss

International Journal of Otolaryngology ◽

10.1155/2014/808759 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 4

Author(s):

Sangeet Kumar Agarwal ◽

Satinder Singh ◽

Samarjit Singh Ghuman ◽

Shalabh Sharma ◽

Asish Kr. Lahiri

Keyword(s):

Hearing Loss ◽

Sensorineural Hearing Loss ◽

Inner Ear ◽

Temporal Bone ◽

Congenital Anomalies ◽

Tertiary Care ◽

Sensorineural Hearing ◽

Tertiary Care Centre ◽

Indian Children ◽

3D Scan

Introduction. Congenital sensorineural hearing loss is one of the most common birth defects with incidence of approximately 1 : 1000 live births. Imaging of cases of congenital sensorineural hearing loss is frequently performed in an attempt to determine the underlying pathology. There is a paucity of literature from India and for this reason we decided to conduct this study in Indian context to evaluate the various cochleovestibular bony and nerve anomalies by HRCT scan of temporal bone and MRI with 3D scan of inner ear in a tertiary care centre.Material and Methods. A total of 280 children with congenital deafness (158 males and 122 females), between January 2002 to June 2013 were included in the study and they were assessed radiologically by HRCT scan of temporal bone and MRI with 3D scan of inner ear.Results. In the present study we found various congenital anomalies of bony labyrinth and vestibulocochlear nerve. Out of 560 inner ears we found 78 anomalous inner ears. Out of these 78 inner ears 57 (73%) had cochlear anomaly, 68 (87.1%) had anomalous vestibule, 44 (56.4%) had abnormal vestibular aqueduct, 24 (30.7%) had anomalous IAC, and 23 (29.4%) had abnormal cochleovestibular nerves.Conclusion. In present study, we found lower incidences of congenital anomalies comparative to existing literature.

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Venous aneurysms — a neglected pathology

Open Medicine ◽

10.2478/s11536-008-0068-0 ◽

2008 ◽

Vol 3 (4) ◽

pp. 503-504

Author(s):

Mazda Turel ◽

Edwin Stephen ◽

Sukria Nayak ◽

Sunil Agarwal

Keyword(s):

Tertiary Care ◽

Surgical Excision ◽

Short Report ◽

Care Centre ◽

Tertiary Care Centre ◽

Treatable Condition

AbstractVenous aneurysms are not often recognised nor given importance due to the more serious and challenging nature of their arterial counterpart. They are uncommon entities that generally present as a painless swelling, can be accurately diagnosed by duplex venous scanning and are completely cured by surgical excision. We present a short report of 14 cases treated at a tertiary care centre in India over seven years from June 2001 to June 2008, to increase awareness of this easily treatable condition.

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Use of Triamcinolone in keloid

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20214063 ◽

2021 ◽

Author(s):

Shwetha B. ◽

Sathyaki D. C.

Keyword(s):

Recurrence Rate ◽

Tertiary Care ◽

Surgical Excision ◽

Weekly Interval ◽

Treatment Modalities ◽

Care Centre ◽

Tertiary Care Centre ◽

Triamcinolone Injection

Background: Keloids are well known for recurrence. There is no standardized regimen for the treatment of keloids. Many different treatment modalities such as surgical excision, intralesional corticosteroids, radiotherapy, and pressure earrings have been used for keloids. Surgical excision alone may result in recurrence rate of 40-100%. Many different modalities of treatment have been tried to prevent recurrence. Aims and objectives of the study was to evaluate the efficacy of Triamcinolone in preventing recurrence of Keloid.Methods: 40 patients who underwent excision of keloid at a tertiary care centre. Surgery alone was performed in 20 patients and surgery with post operative intra lesional Triamcinolone injection was given weekly interval for 6 weeks in another 20 patients. Patients were followed up for the period of 2 yearsResults: Recurrence was found in 5 patients who underwent excision alone and there was no recurrence among patients who received post operative intra lesional triamcinolone.Conclusions: Multi modality treatment is better to prevent recurrence of Keloid.

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MUCORMYCOSIS UBIQUITOUS FUNGUS THRIVING IN IMMUNOCOMPROMISED COVID PATIENT IN PATNA

10.36106/paripex/2400903 ◽

2021 ◽

pp. 20-23

Author(s):

Manish Ranjan ◽

Vineet Sinha ◽

Neha Giri ◽

Abhisek Kishore Dayal ◽

Surbhi Surbhi ◽

...

Keyword(s):

Paranasal Sinuses ◽

Prospective Observational Study ◽

Tertiary Care ◽

Intracranial Extension ◽

Virus Infections ◽

Tertiary Care Centre ◽

History Of ◽

Ethmoid Sinuses ◽

Second Wave ◽

Nasal Biopsy

OBJECTIVE. To study various predisposition for sudden upsurge in mucormycosis in second wave of COVID To study pattern of involvement and spread of disease and to correlate clinicoradiologically METHOD: A prospective observational study was conducted at a tertiary care centre over 2months, involving all patients with mucormycosis of paranasal sinuses with history of corona virus infections and having postive KOH fungal staining on nasal biopsy. RESULT: 30 patients were studied.maxillary and ethmoid sinuses were most affected sinuses.eye involvement was seen in 83.3 percent cases while intracranial extension was seen in 13.3 percent.22 patients gives the history of steroid usage.comorbid condition Diabetes mellitus was being the most common. CONCLUSION:The association between coronavirus and mucormycosis of paranasal sinuses must be given utmost importance.uncontrolled Diabetes and overuse of steroids are main factors.

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Evaluation of Palpable Breast Masses by Ultrasound and its Correlation with Tissue Diagnosis in a Tertiary Care Centre in Northern Kerala

Annals of International medical and Dental Research ◽

10.21276/aimdr.2018.4.1.rd3 ◽

2017 ◽

Vol 4 (1) ◽

Author(s):

Krishnananda Holla ◽

Junise M ◽

Sandeep Sojan ◽

Harshavardhan N

Keyword(s):

Tertiary Care ◽

Care Centre ◽

Tertiary Care Centre ◽

Breast Masses ◽

Tissue Diagnosis ◽

Palpable Breast

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Study of benign neck swellings of anterior neck triangle at a tertiary care centre

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20192709 ◽

2019 ◽

Vol 5 (4) ◽

pp. 941 ◽

Cited By ~ 1

Author(s):

Pradipkumar Digambar Khokle ◽

Vinod Tukaram Kandakure ◽

Ujjwala Madhukar Kolekar

Keyword(s):

Tertiary Care ◽

Surgical Excision ◽

Lateral Neck ◽

Neck Swelling ◽

Thyroglossal Cyst ◽

Tertiary Care Centre ◽

Medical College ◽

Wide Range ◽

Thyroid Swelling ◽

A Prospective Study

Background: Tumors of the neck are interesting to surgeons especially because of the complex neck anatomy and difficult differential diagnosis. The aim is to study different types of neck swellings i.e. thyroid swelling, salivary gland swelling, other neck swellings such as thyroglossal cyst, branchial cyst, lymphangioma and also the miscellaneous and rare lumps in the neck. The study also discusses their age and sex-wise distribution, clinical features, presentation, diagnostic modalities and treatment.Methods: This is a prospective study, conducted at our institute Government Medical College, Latur from June 2017 to May 2018 for a duration of one year. Results: A total of 57 patients were studied during this period. Out of the 57 patients, 47 of them were midline swellings (82.45%) and 10 among them were lateral neck swellings (17.55%). People over a wide range of age group between 5-60 years were affected. Midline neck swelling were more common than lateral neck swellings.Conclusions: Among the midline benign neck swellings, thyroid swelling was found to be the commonest followed by thyroglossal cyst. Thyroid swellings occur more commonly in the females than males. Ultrasound guided FNAC is the most common, effective and safe investigation that aids in the diagnosis. Treatment of choice for benign, non-inflammatory and non-malignant neck swelling is mostly surgical excision rather than medical management.

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High resolution computed tomography of temporal bone in the evaluation of otologic diseases

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20174546 ◽

2017 ◽

Vol 4 (1) ◽

pp. 87

Author(s):

Prakash S. Handi ◽

Mallikarjun N. Patil ◽

Nisha P.

Keyword(s):

Computed Tomography ◽

High Resolution ◽

Ct Scan ◽

Temporal Bone ◽

Middle Ear ◽

Tertiary Care ◽

Age Groups ◽

Tertiary Care Centre ◽

High Resolution Computed Tomography ◽

Bone Anomalies

Background: Conventional radiological methods like X-ray mastoid have limited ability to delineate the details of the complex temporal bone and cochlea-vestibular anatomy and disease pathology. This can be overcome by the use of High resolution computed tomography (HRCT) evaluation of the temporal bone. HRCT is helpful in evaluating the anatomy and pathology type and extent of disease, thereby helps in preoperative planning. Methods: The CT scan of forty five patients attending the outpatient department of otorhinolaryngology in a tertiary care centre between August 2014 to August 2017 was evaluated in this study. Each CT scan was interpreted by an otolaryngologist and a radiologist and interpretation was by consensus. The data collected was evaluated and results are reported as rates and proportions (%). Results: The study evaluated CT scan of 45 patients of which 35 were male patients and 10 were female patients with age ranging from 5 years to 75 years. Most of these patients belonged to the 21-30, 31-40 age groups [9 (20%) in each group]. Infections of middle ear cleft (all with cholesteatoma), fractures of the temporal bone, anomalies and tumors of the external auditory canal and middle ear were the pathologies observed in these CT scans with infection (otomastoiditis) [23 (51.1%)] being the most common pathology observed. Conclusions: Pre-operative CT scan may not only help in identifying the nature, extent of infectious disease including ossicular, bony erosions; it may also identify anomalies in the temporal bone and surrounding structures. Thus, HRCT temporal bone will help the surgeon in planning effective surgical strategy, reducing morbidity during the surgery.

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Glomus Jugulare Tumor Surgery with Intracranial Extension

Otolaryngology ◽

10.1177/019459988008800504 ◽

1980 ◽

Vol 88 (5) ◽

pp. 531-535 ◽

Cited By ~ 15

Author(s):

Sam E. Kinney

Keyword(s):

Temporal Bone ◽

Posterior Fossa ◽

Benign Tumor ◽

Surgical Excision ◽

Intracranial Extension ◽

Tumor Surgery ◽

Total Removal ◽

Glomus Tumors ◽

Glomus Jugulare Tumor ◽

Glomus Jugulare

Total surgical excision of a glomus jugulare tumor is the treatment of choice for this benign tumor. If the tumor has extended beyond the temporal bone into the intracranial spaces, most often the posterior fossa, the surgical excision becomes more difficult. If the tumor has extended anteriorly and posteriorly into the posterior fossa or if a portion of the tumor is exposed in the external auditory canal with the concurrent infection that is seen with this presentation, the intracranial portion of the tumor should be removed as a first step in a planned two-stage removal of the tumor. If the intracranial extension is limited and there is no infection present with the tumor, a combined otologic-neurosurgical approach using transtemporal and suboccipital access to the temporal bone will allow successful total removal of the tumor in a one-stage procedure. Details are presented to demonstrate this combined otologic and neurosurgical approach to large glomus tumors with intracranial extension.

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Cytopathological study of thyroid lesions and its correlation with histopathology in a tertiary care centre of Gujarat – A retrospective study

IP Journal of Diagnostic Pathology and Oncology ◽

10.18231/j.jdpo.2021.024 ◽

2021 ◽

Vol 6 (2) ◽

pp. 109-114

Author(s):

Vandana Patel ◽

Amita Patel

Keyword(s):

Tertiary Care ◽

Physiological Role ◽

Cost Effective ◽

Surgical Excision ◽

Needle Aspiration ◽

Thyroid Diseases ◽

The Body ◽

Histopathological Diagnosis ◽

Tertiary Care Centre ◽

Thyroid Lesions

Thyroid gland is one the important organs, which play a wide and vital physiological role in the body. Thyroid diseases are quite common. The incidence of thyroid diseases depends mainly depending upon iron deficiency status. Fine-needle aspiration cytology (FNAC) plays a vital role in evaluating patients with thyroid nodules. Surgical excision and histopathological evaluation are crucial to establish the diagnosis.This study mainly aims to classify the cytomorphology of palpable thyroid lesions by FNAC and correlate the results with histopathology. This study also aims to determine the spectrum of histopathological diagnosis in thyroid surgeries. The present study was carried out at cytopathology and histopathology section of pathology department of GMERS Medical College, Valsad. In present study, we analysed 276 cases of palpable thyroid nodule underwent FNAC. Out of them 152 cases underwent surgical procedure like lobectomy or partial or total thyroidectomy Out of these 276 patient, females were 218 and males were 58 with F:M ratio of 3.76:1. Out of total 276 patients, 81 (29.3%) were between 31-40 years followed by 75 (27.2%) were between 21-30 years and 237 (85.9%) were fall into category-II. Out of these 152 patients, 88 (57.9%) having colloid goitre and 79 (89.7%) were confirmed histologically. FNAC is an invaluable tool in management of thyroid lesions. It is a safe, simple and cost effective procedure and can be performed on outdoor patients. If the cytology report is malignant, surgery is the recommended procedure; for suspicious lesions, repeat aspiration is required and for benign lesions no further immediate diagnostic studies are required.

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