Removal of an Extensive Nasal Polyp in a Standing Horse, Using a Direct Approach to the Nasal Cavity  Through a Bone Flap

Nasal polyps are not very common in horses, comprising of just about 2,5 % of equine sinonasal disease (Tremaine and Dixon, 2001). However, nasal polyps can develop into extensive masses, obstructing partially or totally air flow thus giving dramatic clinical presentations. The aim of this report was to present a surgical technique used to successfully remove a massive nasal polyp in a standing mare. A 9 year old mixed-breed mare was referred to the equine teaching hospital of the Faculty of Veterinary Medicine in Cluj –Napoca for the evaluation of an extensive, unilateral nasal mass. Upon inspection, a cauliflower-appearing mass was protruding from the right nostril. A decision was made to try to surgically remove the mass using a direct approach through a nasal bone flap. Classic approach through the opening of the nostril was impossible due to the extent of the mass. The surgery was performed with the mare standing under sedation and regional anesthesia. The mass was approximately 30 cm by 7 cm and was described histologically as a nasal polyp. The mare made a full recovery, and there was no recurrence in the next three years after surgery.

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Prevalence of Eosinophilic/Non Eosinophillic Nasal Polyps and Analysis of Their Presentation in Hospital Universiti Sains Malaysia Kelantan, Malaysia

IIUM Medical Journal Malaysia ◽

10.31436/imjm.v16i2.332 ◽

2020 ◽

Vol 16 (2) ◽

Author(s):

Ramiza Ramza Ramli ◽

Irfan Mohamad ◽

Yahia Hussein Al-Hadeethi

Keyword(s):

Nasal Polyp ◽

Nasal Polyps ◽

Local Community ◽

Clinical Symptoms ◽

Histological Study ◽

Inflammatory Cells ◽

Sinus Surgery ◽

Histopathological Diagnosis ◽

Dominant Group ◽

Clinical Presentations

Introduction: This study is aimed to examine the predominant inflammatory cells in nasal polyps (NP) in the local community and its correlation to the clinical presentations. Materials and Methods: The study was done retrospectively looking at patients who had undergone functional endoscopic sinus surgery (FESS) in Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia with a histopathological diagnosis of nasal polyposis (NP), between the years 2004 to 2008. Sixty-two patients between the ages of 18 years to 60 years old were selected and data relevant to the study were collected from the patient’s folders using a specially created form prepared for the study. The NP histopathology report from each patient underwent FESS were analysed and the patients were divided into eosinophilic and non-eosinophilic dominant group. Clinical presentations from each patient were also gathered and analysed according to the NP group. Results: In HUSM, there were a higher number of eosinophilic types NP as compared to the neutrophilic type NP which is contrary to other study conducted on Asian populations. The clinical symptom correlations between either eosinophilic or non-eosinophilic type of NP have not shown any significant associations. Conclusion: The study showed that the incidence of histological subtypes of nasal polyp in HUSM is almost the same as that found in other parts of the world (Europe and North America) which will reduce the possibility of racial or geographical influence on the pathogenesis of the nasal polyp. Clinical symptoms and presentation alone are not enough to differentiate the type of the nasal polyp without the histological study.

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Woakes syndrome

Oto Rhino Laryngologica Indonesiana ◽

10.32637/orli.v44i1.86 ◽

2014 ◽

Vol 44 (1) ◽

pp. 76

Author(s):

Retno Sulistyo Wardani ◽

Ika Dewi Mayangsari

Keyword(s):

Nasal Cavity ◽

Nasal Polyp ◽

Nasal Polyps ◽

Bone Erosion ◽

Aesthetic Surgery ◽

Complete Information ◽

Massive Bleeding ◽

Sinus Surgery ◽

Nasal Bridge ◽

The Right

Background: Extensive nasal polyp growth in the paranasal sinuses can lead to bone erosion of the sinus walls and cause facial disfigurement due to continuous pressure or chronic inflammation. This extremely rare phenomenon is called Woakes syndrome. This syndrome consist of several symptoms include the destruction of ethmoid sinus that cause broadening of the bridge of the nose, frontal sinus aplasia and bronchiectasis. Purpose: To give complete information about the diagnosis and management of Woakes Syndrome. Case: A 16-year-old boy with deformity of the left nose, nasal obstruction and frequent episodes of rhinorrhea since 4 months before admission. Nasoendoscopic evaluation showedhuge nasal polyps filling the left nasal cavity, pushing the septum and narrowing the right nasal cavity. Histopathology result was edematous polyp with necrosis and massive bleeding without signs of malignancy. Management: Patient was managed in two stages operations. First, nasal polyp removal by FESS technique in general anesthesia, and the second stage four months later, was septorhinoplasty for aesthetic bridge reconstruction. Conclusion: Nasal polyps could be related to Woakes syndrome, characterized by broadening of nasal bridge which needs functional and aesthetic surgery. Keyword: Woakes Syndrome, nasal polyps, Functional Endoscopic Sinus Surgery, Septorhinoplasty ABSTRAKLatar Belakang: Polip hidung besar yang meluas dalam sinus paranasal dapat menyebabkan erosi dinding sinus dan menyebabkan cacat wajah akibat tekanan terus-menerus atau peradangan kronis. Fenomena ini sangat langka dan disebut sebagai sindrom Woakes. Sindrom ini terdiri dari beberapa gejala termasuk kerusakan dinding sinus etmoid yang menyebabkan hidung melebar, aplasia sinus frontal dan bronkiektasis. Tujuan: Untuk memberikan informasi yang lengkap tentang diagnosis dan penatalaksanaan Woakes Syndrome. Kasus: Seorang anak laki-laki 16 tahun dengan deformitas hidung kiri, hidung tersumbat dan pilek berulang sejak 4 bulan. Evaluasi nasoendokopi menunjukkanpolip hidung masif mengisi rongga hidung kiri, mendorong septum dan menyempitkan rongga hidung kanan. Pemeriksan histo-patologi memperlihatkan polip edematosa dengan nekrosis dan perdarahan masif tanpa tanda-tanda keganasan. Penatalaksanaan: Pada pasien dilakukan dua tahap tindakan. Pertama, dilakukan Bedah Sinus Endoskopik Fungsional (BSEF) dan polipektomi dalam anestesi umum, dan empat bulan kemudian pasien menjalani septorinoplasti untuk rekonstruksi wajah. Kesimpulan: Polip hidung pada kasus ini kemungkinan terkait dengan sindrom Woakes, ditandai dengan pelebaranpyramid hidung yang membutuhkan tindakan operasi fungsional dan estetika.Kata kunci: sindroma Woakes, polip hidung, Bedah Sinus Endoskopik Fungsional, Septorinoplasti.

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The Role of CD68 (+) Histiocytic Macrophages in Nasal Polyp Development

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0040-1715593 ◽

2020 ◽

Author(s):

Nuray Bayar Muluk ◽

Osman Kürşat Arikan ◽

Pınar Atasoy ◽

Rahmi Kiliç ◽

Eda Tuna Yalçinozan

Keyword(s):

Nasal Cavity ◽

Nasal Polyp ◽

Nasal Polyps ◽

Deep Layer ◽

Ethmoid Sinus ◽

Adult Patients ◽

Control Group ◽

Study Group ◽

Deep Layers

Abstract Objectives The aim of this study was to investigate the role of CD68 (+) histiocytic macrophages (H-M) in the nasal polyp pathogenesis. Materials and Methods The study group consisted of 24 adult patients with nasal polyposis. The control group consisted of 11 adult patients without nasal polyps. A total of 36 nasal polyp samples (10-nasal cavity, 10-maxillary sinus, and 16-ethmoid sinus) from the study group and 11 inferior turbinate samples from the control group were analyzed by immunohistochemical staining, with monoclonal antibodies against CD68 (+) H-M. Results CD68 positivity was significantly higher than the control group in the subepithelial (SE) layer of the ethmoid sinus, and deep layers of nasal cavity, maxillary, and ethmoid sinuses. In SE and deep layers of ethmoid and maxillary sinuses, CD68 positivity was significantly higher than that of the epithelial layer. In the deep layer, histiocytic macrophages tended to gather around eosinophils. Conclusion The high numbers of CD68 (+) histiocytic macrophages mainly located in deep layer of lamina propria may be responsible for the phagocytosis of eosinophils within the polyp tissue. Therefore, it may be concluded that increased macrophages in nasal polyps do not trigger the growth of nasal polyps. Instead, they may serve to reduce the number of eosinophils in already-developed nasal polyps.

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P043 Fascinating phosphate: seek and you will find

Rheumatology ◽

10.1093/rheumatology/keab247.040 ◽

2021 ◽

Vol 60 (Supplement_1) ◽

Author(s):

Jyoti Bakshi ◽

Clare Batten

Keyword(s):

Back Pain ◽

Degenerative Change ◽

Nasal Bone ◽

Rare Condition ◽

Whole Body ◽

Excision Biopsy ◽

Small Lesion ◽

History Of ◽

The Right ◽

Fgf 23

Abstract Background/Aims A 62-year-old accountant was referred to the metabolic bone clinic with a 2 year history of thoracic back pain and a persistently raised ALP. There were no associated red flags for her back pain. She had a history of a gluteal lump, thought to be benign, for which she had declined excision. She has hypertension and had a previous navicular fracture. Medications included bendroflumethiazide and Adcal D3. She had restriction in neck movements and was tender to percussion in the thoracic spine. There was no proximal weakness or focal neurology. Systems and joint exam were unremarkable. Methods The case is discussed below. Results Salient abnormal results on presentation were a raised ALP of 207 and corrected calcium of 2.34. PTH was elevated at 8.2 (NR:1.6-6.9), Vitamin D 79 and a low phosphate of 0.34 (NR:0.8-1.50). Alkaline phosphatase isoenzymes showed the raised level came from bone. Protein and urine electrophoresis were normal. A bone density scan was normal, and a recent thoracic MRI showed only degenerative change. An isotope bone scan was requested and was reported to show increased activity in the nasal bone, maxilla and both orbits, raising the possibility of Paget’s disease. However, when reviewed in the Radiology meeting with a skull x-ray, the appearances were not felt to be in keeping with Paget’s. Despite physiotherapy, hydrotherapy, acupuncture and neuropathic medication the patient’s back pain continued. Her phosphate remained low and her calculated tubular reabsorption of phosphate from a 24h urine collection (TmP/GFR) was low at 0.42mmol/l (NR 0.80-1.35). She was started on phosphate replacement and calcitriol, and Adcal D3 was continued. The Fibroblast Growth Factor (FGF) 23 levels were sent and came back significantly elevated at 1380 (NR < 100). A 68Ga DOTA-TATE scan (whole body PET/CT scan), confirmed the right gluteal lump as the source of the FGF 23. The patient went on to have an excision biopsy and histology confirmed a mesenchymal tumour of the right buttock. Her phosphate replacement was gradually weaned, but on reducing the dose phosphate levels dropped and her symptoms returned. The repeat TmP/GFR was again low at 0.61, and FGF 23 levels were still raised at 204. A repeat 68Ga DOTA-TATE scan, 4 years after the first one, showed recurrence of the right gluteal lesion and a possible small lesion in the left gluteal muscle. She has been sent for further excision. Conclusion Tumour induced osteomalacia (TIO) is a rare condition and should be considered in cases of hypophosphataemia. Classical symptoms are proximal weakness and muscle and bone pain. They are typically associated with small benign tumours (most commonly mesenchymal tumours) which may be difficult to find. Excision is curative but if small amounts of tumour remain, relapses may occur. Disclosure J. Bakshi: None. C. Batten: None.

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1223 Cholelithiasis and Choledocholithiasis with Migration of Stones into Right Psoas Muscle Cavity

British Journal of Surgery ◽

10.1093/bjs/znab259.362 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

J Hunter

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Psoas Muscle ◽

Magnetic Resonance Cholangiopancreatography ◽

Imaging Modalities ◽

Prior History ◽

Clinical Presentations ◽

Multiple Imaging ◽

The Right ◽

Psoas Major

Abstract Aim To highlight the importance of appropriate imaging modalities for abnormal clinical presentations. Method Xyo woman presented with severe right upper-quadrant pain to the emergency department. Prior history of colicky abdominal pain for 1 year, right-sided nephrectomy and hypertension. She stated that the current epsiode of pain was the worst so far, becoming more persistent, prompting her to call an ambulance. Cholecystitis was suspected, so a Computed Tomography abdomen/pelvis was performed. A dilated, inflamed gallbladder was noted in contact with the right psoas major, with what appeared to be an abscess in the right psoas major. Results A Magnetic Resonance Cholangiopancreatography was performed, which demonstrated that the aforementioned abscess was in fact a large cavity within the psoas major, containing up to 15 gallstones. Cholelithiasis was also seen, with common bile duct dilatation and evidence of a common bile duct stone. An Endoscopic Retrograde Cholangiopancreatography was performed, and X recovered well post-procedure with analgesia and antibiotics. Conclusions Acute cholecystitis/intra-abdominal gallstones may result in abscess/cavity formations and abnormal biliary clinical presentations. It is important therefore to fully investigate abnormal hepatobiliary imaging with multiple imaging modalities to allow for accurate diagnosis and appropriate further management of presentations.

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“Craniotomy Within Craniotomy” Technique for Safe Resection of an Intracranial Arteriovenous Malformation With Frontal Bony Erosion: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opab312 ◽

2021 ◽

Author(s):

MirHojjat Khorasanizadeh ◽

Kristine Ravina ◽

Aristotelis Filippidis ◽

Christopher S Ogilvy

Keyword(s):

Surgical Resection ◽

Endovascular Embolization ◽

Acute Onset ◽

Bone Flap ◽

Intracranial Arteriovenous Malformation ◽

Excessive Bleeding ◽

Left Hand ◽

The Right ◽

Venous Varix

Abstract Surgical resection is one option in the treatment of large high-grade brain arteriovenous malformations (AVMs). Resection of AVMs with skull-eroding components can be challenging due to the risk of excessive bleeding from these components during craniotomy and bone flap removal. We present a case of a 25-yr-old woman who presented with an acute onset right-sided frontal headache. She was found to have a large, frontal Spetzler-Martin grade IV AVM with an associated dural AVM. The AVM had caused focal erosions of the right frontal bone by a venous varix traversing the region of the calvarial defect. An elective staged endovascular embolization followed by surgical resection was recommended considering the patient's young age and the large size of the AVM located in a noneloquent area. Given the high risk of intraoperative hemorrhage during the craniotomy portion of the procedure, a “craniotomy within craniotomy” approach was planned. During this approach, a small rectangle of bone, including the portion eroded by the venous varix, was left in place, while the larger bone flap surrounding it was removed for an initial approach to the AVM. The small bony piece was safely removed at later stages of resection once the arterial feeders had been reasonably obliterated. Immediate postoperative catheter angiogram demonstrated good filling of the intracranial vascular territories with no residual AVM. The patient developed mild left facial and left hand weakness postoperatively, which resolved after 2 wk of follow-up. The patient remained neurologically intact on further follow-up.

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Bilateral lamellar keratoplasty in descemetocele treatment in dog with botulism by use of equine renal capsule and conjunctival pedicle graft

Ciência Rural ◽

10.1590/s0103-84781999000200029 ◽

1999 ◽

Vol 29 (2) ◽

pp. 355-359 ◽

Cited By ~ 1

Author(s):

José Luiz Laus ◽

Paula Diniz Galera ◽

Ruben Pablo Schocken-Iturrino ◽

Marluce de Macedo Cavassani ◽

Alexandre Lima de Andrade

Keyword(s):

The Other ◽

Lamellar Keratoplasty ◽

Renal Capsule ◽

Other Hand ◽

Mixed Breed ◽

The Right

A 3-year-old, male mixed breed dog with botulism and bilateral descemetocele was submitted to lamellar keratoplasty with equine renal capsule preserved in glycerin in the right eye and conjunctival pedicle graft in the left eye. The evolution was satisfactory in both eyes, but better in the eye receiving the equine renal capsule, because the corneal transparence was more evident in that eye. On the other hand, the surgical period was more quickly in the eye receiving the equine renal capsule because the preparation of the conjunctival pedicle before the keratoplasty was not necessary.

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Are Artificial Intelligence (AI) And Machine Learning (ML) Having An Effective Role In Helping Humanity Address The New Coronavirus Pandemic?

WSEAS TRANSACTIONS ON BIOLOGY AND BIOMEDICINE ◽

10.37394/23208.2020.17.14 ◽

2020 ◽

Vol 17 ◽

Keyword(s):

Artificial Intelligence ◽

Machine Learning ◽

Disease Outbreaks ◽

Hospital Capacity ◽

Data Engineering ◽

Clinical Presentations ◽

The Face ◽

Effective Role ◽

Using Data ◽

The Right

COVID-19 has become a pandemic affecting the most of countries in the world. One of the most difficult decisions doctors face during the Covid-19 epidemic is determining which patients will stay in hospital, and which are safe to recover at home. In the face of overcrowded hospital capacity and an entirely new disease with little data-based evidence for diagnosis and treatment, the old rules for determining which patients should be admitted have proven ineffective. But machine learning can help make the right decision early, save lives and lower healthcare costs. So, there is therefore an urgent and imperative need to collect data describing clinical presentations, risks, epidemiology and outcomes. On the other side, artificial intelligence(AI) and machine learning(ML) are considered a strong firewall against outbreaks of diseases and epidemics due to its ability to quickly detect, examine and diagnose these diseases and epidemics.AI is being used as a tool to support the fight against the epidemic that swept the entire world since the beginning of 2020.. This paper presents the potential for using data engineering, ML and AI to confront the Coronavirus, predict the evolution of disease outbreaks, and conduct research in order to develop a vaccine or effective treatment that protects humanity from these deadly diseases.

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Seminoma and sertolioma in non-cryptorchid dog – case report

Acta Veterinaria Brasilica ◽

10.21708/avb.2021.15.4.10155 ◽

2021 ◽

Vol 15 (4) ◽

pp. 281-286

Author(s):

Guilherme Mantuani Silva ◽

Isabela Cristina de Oliveira ◽

Rodrigo Samuel de Toledo ◽

Juliana Evangelista Bezerril ◽

Gabriela Maria Benedetti Vasques ◽

...

Keyword(s):

Physical Examination ◽

Ultrasound Examination ◽

Histopathological Examination ◽

Seminiferous Tubules ◽

Biochemical Tests ◽

Predisposing Factor ◽

Left Testicle ◽

Spindle Cells ◽

Mixed Breed ◽

The Right

The most common testicular neoplasms in dogs are seminoma, leydigocytoma and sertolioma, affecting middle--aged and elderly dogs, where cryptorchidism is a predisposing factor, as well as some breeds. It can occur alone or, less fren-quently, concurrently, generally affecting the same testicle. This study aimed to report the case of a non-cryptorchid 14-year--old mixed breed dog diagnosed with seminoma and sertolioma, each in a testicle. The animal showed an increase in scrotal volume, with no changes in other clinical parameters on physical examination. On ultrasound examination, it was possible to observe alterations suggestive of neoplasia in both testicles and prostatic alteration suggestive of benign prostatic hyperplasia. Complementary blood count and biochemical tests were performed and, as treatment, orchiectomy was performed. Fragments were collected from both testicles and sent for histopathological examination. Microscopy of the left testicle showed the presence of round cells, multiple and evident nucleoli, cells in different phases of mitosis and binucleation, these changes being compa-tible with seminoma. In contrast, in the right testicle, spindle and elongated cells (pseudo-lobular) were observed, presence of long cytoplasmic projections with rounded ovoid nucleus, spindle cells and degeneration of seminiferous tubules, compatible with sertolioma. It was observed that physical examination associated with ultrasound was efficient to detect the presence of neoplasms, being validated by histopathological examination. Orchiectomy was an assertive treatment indicated for this case.

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Onlay Silicone and Hydroxyapatite-Tricalciumphosphate Composite (HAP-TCP) Blocks Interfere with Nasal Bone Growth in Rabbits

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_1995_032_0282_osahtc_2.3.co_2 ◽

1995 ◽

Vol 32 (4) ◽

pp. 282-289

Author(s):

Minoru Arakaki ◽

Shunichi Yamashita ◽

Mehmet Mutaf ◽

Shinji Naito ◽

Tohru Fujii

Keyword(s):

Bone Tissue ◽

Bone Growth ◽

Nasal Bone ◽

Growth Period ◽

Blood Biochemistry ◽

Hydroxyapatite Ceramic ◽

Cross Sectional ◽

Porous Hydroxyapatite ◽

New Type ◽

The Right

We investigated how a new type of synthetic porous hydroxyapatite ceramic (HAP-TCP) acts when it is implanted in growing membranous bone. Seventy-six New Zealand White infant male rabbits (4-week-olds) were used. Rabbits received HAP-TCP block or silicone block implantation in their right nasal bone. The left nasal bone was used for a sham. Serial or cross-sectional examinations by morphometry, radiology, blood biochemistry, and histology were carried out. Both the HAP-TCP and silicone groups exhibited no systemic growth disturbance in terms of morphometry and blood biochemistry. Dual energy x-ray absorptiometry (DEXA) revealed, however, a decrease in the bone mineral content (BMC) of the right nasal bone in the silicone group. Histology revealed a superior affinity of HAP-TCP to bone tissue than that of silicone. When a HAP-TCP block was implanted under the periosteum it bonded directly to bone tissue. However, sinking of the implants into the bone tissue were noted both in the HAP-TCP and the silicone groups in longitudinal observation. These results suggest that although HAP-TCP has superior affinity to bone tissue, this by itself is not enough sufficient reason to believe that HAP-TCP can be effectively applied during the growth period.

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