Facial Swelling and Dyspnea as Presenting Symptoms for Non-Hodgkin’s Lymphoma

The Association of Fracture Displacement and Surgical Intervention in Isolated Zygomatic Arch Fractures.

Lymphomas of the sinonasal tract are a rare and heterogeneous subset of solid sinonasal neoplasms. To characterize, in this case series, presenting symptoms, treatment modalities, and outcomes for patients with sinonasal lymphoma within a single institution. Retrospective patient data were collected from an academic, oncologic center and entered into a repository designed to capture outcomes for sinonasal malignancies. Patient demographics, presenting symptoms, imaging findings, treatment modalities, and health status were retrospectively extrapolated and evaluated by using Kaplan-Meier estimations for survival probability. Patients with sinonasal lymphoma with a mean follow-up of 50 months were identified (n = 18). Histologic diagnosis included the following: diffuse large B-cell lymphoma (n = 9), natural killer/T-cell lymphoma (n = 5), follicular lymphoma (n = 1), T-cell lymphoma (n = 1), and lymphoma-not otherwise specified (n = 2). The most frequent presenting symptoms were nasal obstruction (78%), facial pain (72%), facial swelling (50%), and nasal discharge (44%). Treatment before lymphoma diagnosis included antibiotics (83%), oral steroids (22%), decongestants (22%), and topical steroids (11%). Treatment regimens after diagnosis included both chemotherapy (94%) and chemoradiotherapy (56%). Survival rates by lymphoma subtype were 56% for B-cell lymphoma and 40% for natural killer/T-cell lymphoma. Overall, 2- and 5-year survival rates were 67% and 50%, respectively. The combination of chemotherapy and radiation resulted in significantly higher survival rates (p ≤ 0.001) than chemotherapy alone. Sinonasal lymphomas are characterized by meager survival rates, which differ by histopathologic subtype. The diagnosis of sinonasal lymphoma is challenging because symptoms frequently parallel those of chronic rhinosinusitis. Increased awareness of these rare malignancies may improve detection and more timely treatment. Clinical trial registration NCT01332136.

Two adult cases of multisystem inflammatory syndrome associated with SARS-CoV-2

Introduction
 Mucoceles occur most frequently in the frontal and ethmoidal sinuses, without gender prevalence. Presenting symptoms can include facial pain, headache, nasal obstruction, diplopia, decreased visual acuity, orbital globe displacement, facial swelling and meningitis, depending on the anatomic area involved. The gold standard in terms of diagnostic precision is computed tomography scan.
 Case Report
 The present study describes case of frontoethmoidal mucocele with orbital involvement that was treated by transnasal endoscopic approach obtaining good outcomes, demonstrating safety and efficacy of this surgical approach.
 Conclusion 
 Transnasal endoscopic management of mucoceles is preferred due to minimal trauma and less morbidity.

Sialoendoscopy and the management of pediatric sialolithiasis.

Background Allergic fungal rhinosinusitis (AFRS) is a chronic inflammatory condition of the sinonasal mucosa with a propensity for postoperative recurrence despite surgical intervention. Understanding the factors contributing to recurrence is crucial for optimizing treatment outcomes. Study aim This retrospective cohort study aimed to assess demographic, clinical, pathological, and procedural factors associated with postoperative recurrence in AFRS patients undergoing functional endoscopic sinus surgery (FESS). Methodology Medical charts of 76 AFRS patients who underwent FESS between January 2008 and August 2021 at Prince Sultan Military Medical City in Riyadh, Saudi Arabia, were reviewed. Demographic data, clinical characteristics, comorbidities, surgical complications, histopathological findings, and postoperative outcomes were analyzed. Statistical analysis included the chi-square test and t-test. Results Relapse was observed in 42 (55.3%) patients. Significant predictors of relapse included younger age (24 ± 9 years in relapsing patients vs. 37 ± 17 years in non-relapsing patients, p < 0.001*), shorter time from presentation to surgery (229.8 ± 303.3 days in relapsing patients vs. 883.9 ± 1145.9 days in non-relapsing patients, p = 0.001*), and certain presenting symptoms such as facial swelling (p < 0.001*). Positive intraoperative cultures were more common in relapsing patients (73.3% vs. 36.4%, p = 0.029), and orbital extension was significantly associated with relapse (73.1% vs. 26.9%, p = 0.024). Surgical complications were more frequent among relapsing patients, although not statistically significant (85.7% vs. 52.2%, p = 0.089). Conclusions Our study highlights the multifactorial nature of postoperative recurrence in AFRS. Younger age, shorter time from presentation to surgery, specific severe presenting symptoms, positive intraoperative cultures, and orbital extension are significantly associated with higher relapse rates in AFRS patients. These findings highlight the need for tailored management strategies to reduce relapse rates, including aggressive and prolonged medical therapy, comprehensive preoperative assessments, and meticulous surgical and postoperative care.

Behcet's disease (BD), also known as Behcet's syndrome, is a rare, chronic, autoimmune disorder of unknown origin. Its manifestations are thought to be caused by vasculitis, resulting in damage to blood vessels of all sizes throughout the body. We report a 25-year-old Pakistani male who is sexually active and presents with a one-year history of shortness of breath, cough, exertional dyspnea, and neck and facial swelling. On examination, he had severe anemia, mouth ulcers, distended neck and chest veins, prominent abdominal veins, and a scrotal ulcer. After going through mandatory investigations to evaluate the presenting signs and symptoms, thromboses were found in the major veins, including the superior vena cava (SVC) and external iliac vein, as well as a positive pathergy test. Accordingly, a diagnosis of Behcet’s disease with cardiomyopathy and venous thrombosis was made. He was treated with anticoagulants, steroids, and azathioprine for six months and subsequently went into remission.

Superior venacava (SVC) thrombus is a condition requiring immediate diagnosis and treatment. SVC thrombus causes obstruction of blood flow through the SVC resulting in severe decrease in venous return from the head, neck and upper extremity to the heart. The presenting symptoms of SVC obstruction include headache, hoarseness of voice, dyspnea, and laryngeal edema, dizziness, swelling of face, neck, and upper extremity. We hereby present a case of SVC thrombus who presented to the casualty department of COMS-TH with features of SVC syndrome which was diagnosed and managed promptly.JCMS Nepal. 2016;12(1):33-5.

Background and objectives: Chronic kidney disease (CKD) is an important, chronic, noncommunicable disease epidemic that affects the world. Lack of registries precludes an accurate estimation of the number of patients with CKD. Only a few studies are done in our country to assess etiology of CKD in young patients. This study was aimed to assess the etiology of CKD in young patients. Materials and Methods: Data were collected from 50 patients of CKD between 15 and 40 years age who presented to Government General Hospital, Kurnool from July 2012 to June 2013. They were clinically evaluated and underwent relevant investigations including renal biopsy in indicated cases. Results: Of the 50 patients studied, there was an overall male preponderance over all age groups with a mean age of 27.6 ± 4.9 years. Small kidneys were seen in 70% of patients. 92% of patients had proteinuria. Most common symptoms of presentation were related to gastrointestinal disturbances, breathlessness, easy fatigability, and urinary disturbances. Pallor, pedal edema, and facial puffiness were major clinical features. Majority (62%) had CKD of unknown etiology. In this unknown etiology patients, majority were found to have glomerular disease (42%) based on clinical presentation and other supporting investigations. 92% presented in stage IV or stage V CKD. Histopathologically etiology was proven among 19 patients (38%) with renal biopsy. Conclusion: It is concluded that male patients in the third and fourth decades were in the majority requiring medical care. Chronic Glomerulonephritis of unknown causes constitutes a major etiology among the young presenting in late stages of CKD.

Background and objectives: Chronic kidney disease (CKD), an important, chronic, noncommunicable disease is now one of the major public health problems in our country. Early detection of CKD is crucial to prevent its progression, and thereby, to potentially improve its outcome. Number of young patients with CKD are increasing day by day. Only a few studies are done in our country to assess etiology of CKD in young patients. This study was aimed to assess the etiology of CKD in young patients.&#x0D; Materials and Methods: Data were collected from 150 patients of CKD between 15- and 40-years age who presented to Jahurul Islam Medical College Hospital, Kishoregonj from Jan 2015 to Dec 2019. They were clinically evaluated and underwent relevant investigations including renal biopsy in indicated cases.&#x0D; Results: In this study, there was an overall male preponderance (60.67%) with age range of 31-35 years (32%). Most common symptoms of presentation were related to gastrointestinal disturbances (70%), breathlessness (66%), easy fatigability (62%), and urinary disturbances (56%). Pallor, pedal edema and facial puffiness were major clinical features. Small kidneys were seen in 65.33% of patients. 90 % of patients had proteinuria. Majority (46.67%) had CKD of unknown etiology. In this unknown etiology patients, most of them were found to have chronic glomerulonephritis based on clinical presentation and other supporting investigations. Diabetic nephropathy and obstructive uropathy were found in 13.33% patients. 80% patients were presented in stage IV and stage V CKD. Histopathologically, etiology was proven among 46 patients (30.67%) with renal biopsy.&#x0D; Conclusion: It is concluded that male patients in the second and third decades were in the majority requiring medical care. Chronic Glomerulonephritis of unknown causes constitutes a major etiology among the young presenting in late stages of CKD.&#x0D; AKMMC J 2020; 11(2) : 124-127

Extranodal NK/T-Cell Lymphoma, Nasal Type: Experience of Management in a Referral Hospital in a Development Country.

Baseline characteristics of patients with Gaucher disease enrolled in the taliglucerase alfa surveillance (TALIAS) registry

Background and objectiveNasal and paranasal lesions are one of the most common otorhinolaryngological presentations encountered in clinical practice. Common presenting symptoms of these lesion range from nasal blockades, facial swellings, pain, nasal discharge, and epistaxis to orbital and ear symptoms. Diagnosis can be tricky as these symptoms are common in inflammatory conditions and tumors. The aim of our study was to observe the epidemiology and clinical pathological findings in patients with nasal and paranasal masses presenting to our institute and discuss the challenges in proper diagnosis and management due to similar presentations, and the role of histopathological examination (HPE) and immunohistochemistry (IHC) in overcoming these challenges.MethodsThe IPD records of 396 patients were taken up for the study. All the specimens were sent in 10% neutral buffered formalin for examination as biopsy for diagnosis or after surgical excision. After adequate fixation, the biopsy specimen was submitted for routine processing, followed by paraffin embedding, and stained with hematoxylin and eosin (H&E). Special stains like periodic acid-Schiff (PAS) and Ziehl-Neelsen (ZN) stains for acid-fast bacilli (AFB) were used as required. IHC was performed in the required samples. IHC markers were performed on representative paraffin-embedded sections according to the streptavidin-biotin immunoperoxidase technique as needed. The findings were noted, and histology was correlated with clinical presentations and investigations, tabulated, and statistically analyzed using SPSS Statistics (IBM, Armonk, NY).ResultsOf note, 67.92%% were non-neoplastic lesions whereas 18.18% came out to be benign neoplasms and 13.88% were malignant lesions on HPE. Nasal obstruction was the most common presenting symptom (73.23% of patients) followed by nasal mass (64.14% of cases). Inflammatory sinonasal polyps were the most prominent cases in our study, accounting for 41.16% of all lesions; 18.68% fungal RS (mucormycosis) were seen in our study and 4.54% were cases of juvenile nasopharyngeal angiofibroma (JNA). The majority of benign neoplasms encountered were Schneiderian papilloma or inverted papilloma (06.81%). Eighteen (4.54%) cases of squamous cell carcinomas (SCC) were seen in our study and 2.77% (n=11) cases were of adenoid cystic carcinoma. Of 18 cases of SCC, moderately differentiated SCC carcinoma accounted for 10 cases followed by poorly differentiated SCC (5/18) and nonkeratinizing SCC (3/18). IHC for p40 was performed in all the cases of nonkeratinizing SCC, which showed strong and diffuse nuclear positivity.ConclusionThe nasal cavity is the site of the most varied presentation of tumors in the upper respiratory tract. Mass in the nose and paranasal sinus (PNS) form a heterogeneous group of lesions with varied histopathological features. The proximity of the area to the eyes and brain warrants early definitive diagnosis so that the lesion is treated before it can involve important and vital centers. Even though malignant nasal tumors have a very low incidence, they cause a lot of morbidity due to their long course and frequent local recurrences. Nasal tumors tend to become polypoidal. Epithelioid papilloma of the nasal cavity often resembles a nasal polyp. Clinical diagnosis can be challenging due to similar presentations and appearances, and hence histological examination is a vital tool for the timely diagnosis of such patients.

Percutaneous thrombectomy of upper extremity and thoracic central veins using Inari ClotTriever System: Experience in 14 patients

Frontal sinus fractures (FSF) are relatively uncommon and can be challenging for trauma surgeons to manage. Patients with FSF typically present with facial swelling, pain, and nasofrontal ecchymosis. Here we present a rare case of a patient with FSF and anterior table fracture where the main presenting symptom was bilateral frontal paralysis. We outline our management strategy and review the current literature in regard to management of FSF.