Evaluation for cause of hematuria: Cracking the mystery

Gross hematuria, besides being a serious renal disorder, is quite worrisome for the patients. It merits evaluationto determine the underlying cause and initiate timely management in order to prevent long term complications as well as permanent renal damage in some cases. Anatomical abnormalities causing gross hematuria are rare and often asymptomatic, hence not diagnosed routinely. Here we present two cases of gross hematuria with underlying anatomical abnormality known as the Nut Cracker Syndrome (NCS).

A Rare Case of Isolated Cecal Necrosis

Isolated cecal necrosis is a rare abdominal condition. Usually presents as acute appendicitis clinically. Mostly occurring in older patients with cardiac and renal comorbidities. Anatomical abnormality of cecal blood supply is usually observed. Diagnosis is difficult preoperatively without high degree of suspicion. Any delay in diagnosis can lead to fatal complication. Key words: isolated cecal necrosis, ischemic colitis, acute appendicitis.

Bilateral Severely Stenotic Jugular Foramen: Diagnosis and Management from the Otologist/Neurotologist Point of View

Bilateral jugular foramen stenosis with jugular bulb and vein aplasia is rare in nonsyndromic craniosynostosis and usually diagnosed during childhood. We present a case of bilateral jugular foramen stenosis with jugular bulb and vein aplasia, with subsequent persistence and enlargement of the fetal venous anastomosis in the middle and posterior cranial fossa, along with a review of the literature about this anatomical abnormality, highlighting the surgical challenges and management from the otologist/neurotologist point of view.

3D-Customized Guiding Template for Posterior Fixation in Complex Atlantoaxial Instability—Preliminary Experiences of National Cheng Kung University Hospital

Objective Atlantoaxial fixation is technically demanding and challenging, especially in cases with anatomical abnormality. The purpose of this study is to report the effectiveness of the three-dimensional (3D)-customized guiding template for placement of C1 and C2 screws in cases with abnormalities. Method Two patients with anatomical abnormality and one without were included. The preoperative computed tomography (CT) image was analyzed using our software. The entry point, trajectory, and depth of the screws were designed based on these images. Templates with screw guiding cylinders and cervical spine model were created. In operation, guiding templates were applied directly to the laminae. Drilling, tapping, and screwing were performed through the cylinders. To evaluate the accuracy, deviation of the screw axis from the preplanned trajectory was measured on postoperative CT. A classification system was taking to evaluate the pedicle screw insertion. Results In complex cases, one of C2 screws has grade 2 deviation, and two has grade 1. There was no deviation in screws of C1. All patients achieved symptoms free after 6 months follow-up. Conclusion Although 3D-printed template for atlantoaxial fixation still has limitation in complex cases, it has been proved usefulness and makes the most difficult and dangerous spinal posterior fixation easy to achieve.

Anomalies of the facial nerve: a surgeon’s nightmare

<p class="abstract"><strong>Background:</strong> Most of the anomalies of the facial nerve have been encountered during otological surgery or dissection of the temporal bones. ENT surgeons are taught from a nascent stage to always be wary of an anomalous facial nerve during otological surgery. Today’s surgeon is assisted with high definition imaging and nerve monitoring; yet iatrogenic facial palsy still is encountered even today.</p><p class="abstract"><strong>Methods:</strong> This study was conducted in a select population of patients who reported with aural symptoms with an aim to see the number of facial nerve anomalies one encounters during aural surgery. The filter applied was no patient with congenital anomaly was considered and patients with squamous COM were also excluded. </p><p class="abstract"><strong>Results:</strong> Almost 4.5% of the patients subjected to surgery had varying kinds of facial nerve anomaly, the most common being dehiscence of the fallopian canal.</p><p class="abstract"><strong>Conclusions:</strong> Facial nerve anomalies are not so uncommon as one expects it to be. So it is mandatory that every ENT surgeon should be well versed with facial nerve anatomy and be wary of any structural anatomical abnormality, and irrespective of the experience it pays to be extra cautious when operating on the ear because in the event of damage to the facial nerve the patient has to carry the stigma of a facial deformity for his/her life.</p>

Ultrasound to depict anatomical abnormality: an example of potential alliance of rehabilitation professionals.

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