Unilateral Presentation Research Articles

A new cannula for suction removal of parenchymal tissue of gynaecomastia

Background: There are various surgical techniques that are available for surgical management of gynecomastia. The aim of the study was to evaluate the cosmetic results and patient satisfaction of a combined liposuction with excision for gynecomastia.Methods: Clinical records of patients affected by gynecomastia referred to our department between between 2015 and 2018 were analyzed, total of 23 patients were included in the study.Results: Overall 23 patients underwent surgery for gynecomastia in the study period, a total of 42 breasts were operated as most of the cases were bilateral in nature. 19 patients had bilateral presentation while 4 patients had unilateral presentation. 35 breasts (80%) were operated with a combined liposuction and excision. Liposuction addresses the fatty gynecomastia whereas open excision is used to remove the glandular enlargement. Four patients underwent excision alone as these patients had a firm retro-areolar lump that was suspicious for malignancy. Another four patients underwent liposuction alone.Conclusions: Surgery is the main stay of management of gynecomastia. Liposuction with excision has had the best outcome with good cosmetic results, acceptable complication rates and good patient satisfaction.

No Evidence of Improved Emotion Perception Through Unilateral Hand Contraction.

Previous studies have identified improved cognitive performance from unilateral hand contraction to effect contralateral hemisphere activation. As little is known of whether this activation can improve emotion perception, this study examined any differences in perception accuracy and reaction times of matching photographs of human facial expressions presented to the left or right visual fields after left versus right hemisphere activation triggered by unilateral hand contractions. We used photographs of happy, sad, and neutral facial expressions presented briefly and simultaneously (two photographs in each presentation) either unilaterally (intrahemisphere condition) or bilaterally (interhemisphere condition). We recruited 68 university student participants (aged 19–23 years) and randomly assigned half of them to squeeze a dynamometer with the right hand, while the other half squeezed with the left hand, prior to performing the Dimond face-matching task. Matching of happy faces was faster than matching of sad faces. In females (but not males), perception accuracy was higher when stimuli were presented in the right (vs. left) visual field. We found no difference in emotion perception of photographs in either unilateral (intrahemispheric) or bilateral (interhemispheric) stimuli presentations as a function of hand contractions.

Lower extremity characteristics in recurrent clubfoot: Clinical and gait analysis findings that may influence decisions for additional surgery

BackgroundPatients with recurrent clubfoot may seek intervention to address impairments that impact gait function. An understanding of these impairments and associated gait issues will provide valuable information about ongoing treatment requirements. Research QuestionThe purpose of this study was to describe the prevalence of impairments and associated gait deviations in children with recurrent clubfoot and to evaluate whether these findings differ depending on unilateral or bilateral presentation. MethodsEighty-four affected feet (42 unilateral, 21 bilateral) were retrospectively reviewed. History, clinical exam, and gait data were collected. Statistical analysis included evaluations of associations between clinical exam and gait parameters and differences among patients with unilateral versus bilateral clubfoot and a database of healthy controls. ResultsThe average age was 7.5 ± 3.3 years for unilateral and 7.0 ± 2.8 years for bilateral patients. Patients presented with limited passive ankle dorsiflexion (unilateral/bilateral:67%/57%), limited ankle plantar flexion strength (unilateral/bilateral:53%/55%), metatarsus adductus (unilateral/bilateral:86%/83%) and internal foot-thigh angles (unilateral/bilateral:83%/82%), while only a subset presented with internal bi-malleolar axis angles (unilateral/bilateral:36%/45%). The most common gait deviations were internal foot progression (unilateral/bilateral:76%/73%), external hip rotation (unilateral/bilateral:66%/69%), reduced peak ankle plantar flexion moments (unilateral/bilateral:84%/83%), and reduced peak ankle power generation (unilateral/bilateral:67%/74%). Passive dorsiflexion was significantly correlated with peak dorsiflexion during stance and swing in both groups. Patients with unilateral compared to bilateral clubfoot showed decreased peak dorsiflexion and an associated knee flexor moment. SignificancePatients with recurrent clubfoot show gait deviations at the ankle that can be explained by joint level impairment and compensations at the knee, hip and pelvis. Patients with unilateral clubfoot typically show decreased dorsiflexion range of motion and associated greater gait impacts and compensations than bilateral clubfoot. Understanding the relationships between impairments and gait function and the implications of unilateral versus bilateral clubfoot will help improve prognostic ability and optimize future treatment outcomes.

Long-Term Ophthalmic Outcomes in Pediatric Orbital Cellulitis: A Prospective, Multidisciplinary Study From a Tertiary-Care Referral Institute

To analyze the clinical profile, radiological features, and ophthalmic outcomes of the multidisciplinary management of children with pediatric orbital cellulitis. A prospective, interventional study of patients diagnosed as having pediatric orbital cellulitis was conducted. A complete history, clinical examination, laboratory work-up, radiology (computed tomography [CT]), multidisciplinary consultations (otolaryngology, pediatrics, and microbiology), and treatment plan were obtained for all children. The patients were admitted to the hospital and administered intravenous broad-spectrum antibiotics. Orbital and subperiosteal abscesses were drained via an endonasal or external route. Functional endoscopic sinus surgery was performed when necessary. After a minimum follow-up of 12 months, visual acuity, pupillary reaction, extraocular movements, and proptosis were evaluated as the outcome measures. Forty patients (male = 28, 70%) had unilateral presentation of pediatric orbital cellulitis at a mean age of 7.5 years (range: 4 to 12 years). At presentation, all patients had eyelid edema, conjunctival congestion, and chemosis: 38 (95%) had proptosis, 36 (90%) had decreased extraocular movements and pain, 16 (40%) had a relative afferent pupillary defect, and 6 (15%) had exposure keratitis and optic disc edema. CT scans showed sinusitis in 30 (75%) patients, orbital abscess in 14 (35%) patients, and subperiosteal abscess in 5 (12.5%) patients. At a mean follow-up of 15 months, 30 (75%) patients had complete success, 8 (20%) patients had partial success, and the treatment failed in 2 (5%) patients. No patient had any life-threatening complications. The multidisciplinary management of pediatric orbital cellulitis provides satisfactory long-term ophthalmic outcomes. Ethmoidal sinusitis is the most common etiology of pediatric orbital cellulitis, and endoscopic abscess drainage and functional endoscopic sinus surgery are minimally invasive and provide rapid relief in children. [J Pediatr Ophthalmol Strabismus. 2019;56(5):333-339.].

The Development of Trigger Thumb in the Contralateral Thumb in Pediatric Patients Presenting Initially With Unilateral Involvement.

Background: Pediatric trigger thumb is a common condition that can occur bilaterally. There have been reports of a metachronous relationship between trigger thumbs developing in both extremities. Surgeons might consider delaying operative treatment of unilateral trigger thumb due to the concern that contralateral symptoms may develop later in childhood, requiring a second procedure and anesthetic event. Methods: We retrospectively reviewed patients diagnosed with pediatric trigger thumb from 2008 to 2016 at a large pediatric hospital. Data collected included age at presentation and onset, laterality, age and timing of onset of contralateral symptoms, time of index procedure and subsequent procedure (if any), severity of symptoms, previous treatments, range of motion, and birth history. Results: There were 198 patients with pediatric trigger thumb, with 55 patients (28%) presenting with or developing bilateral involvement. Fifty patients (25%) had bilateral involvement upon initial presentation. Five patients (3%) were subsequently diagnosed with contralateral trigger thumb after initial presentation of unilateral trigger thumb. Average time to contralateral trigger thumb development was 12 months after presentation in unilateral patients. Most patients presented with locked flexion contracture with palpable Notta's nodule. Of the 5 patients who developed contralateral trigger thumbs, three required a second surgery after the index procedure. Conclusions: The vast majority of patients with bilateral trigger thumbs had bilateral involvement upon initial presentation to the pediatric hand clinic. Given the rarity of bilateral symptoms after initial unilateral presentation, we do not recommend delayed surgical intervention for patients with unilateral disease in children over 3 years of age.

Rationale for Study of the Deep Subfascial Lymphatic Vessels During Lymphoscintigraphy for the Diagnosis of Peripheral Lymphedema.

The current study aimed to determine the utility of including the study of deep subfascial lymphatic vessels in a 2-compartment lymphoscintigraphy for the diagnosis of lymphedema in patients with limb swelling. Lymphoscintigraphy is a valuable imaging tool for the timely diagnosis of peripheral lymphedema. However, there is a lack of standardization in its application, especially regarding which type of lymphatic vessels to examine (superficial, deep, or both). Two hundred fifty-eight patients with lymphedema underwent segmental lymphoscintigraphy. The transport index (TI) was calculated to categorize the flow of the superficial and deep vessels as normal (<10) or pathological (≥10). The scores from 248 patients (48 unilateral arm, 86 unilateral leg, 114 bilateral leg) were tested with a 3-way analysis of variance to examine the relationship between affected limb, deep or superficial pathways, and primary or secondary lymphedema. The relationship between clinical presentation and TI was also investigated. In general, primary and secondary lymphedema patients had similar patterns of lymphoscintigraphic lymphatic abnormalities. Patients with unilateral clinical presentation can have bilateral TI abnormalities. The vast majority of patients (88%-98%) had either the deep subfascial vessels alone, or both the superficial and deep vessels, with a pathological TI. A 2-compartment lymphoscintigraphy is able to accurately detect lymphatic flow abnormalities in patients with limb swelling. Given that the vast majority of patients had deep lymphatic vessels abnormalities, inclusion of these vessels in the lymphoscintigraphic diagnostic protocol is recommended.

RETINOBLASTOMA IN INDIA: Clinical Presentation and Outcome in 1,457 Patients (2,074 Eyes).

To study the clinical presentation, treatment, and outcome of patients with retinoblastoma (RB) in India. Retrospective study of 1,457 patients with RB (2,074 eyes). The mean age at presentation of RB was 29 months (median, 24 months; range, <1-370 months). There were 812 (56%) men and 645 (44%) women with unilateral presentation of RB in 57% (n = 834) and bilateral in 43% (n = 623). Familial RB was present in 4% (n = 55). The most common presenting complaints included leukocoria (n = 1,100; 75%), proptosis (n = 91; 6%), strabismus (n = 77; 5%), and red eye (n = 68; 5%). Most (n = 1,889; 91%) tumors were intraocular in location, and 185 (n = 185; 9%) had extraocular tumor extension at presentation. The most common modalities of primary treatment-included systemic chemotherapy (n = 1,171; 60%) and enucleation (n = 674; 35%). At a mean follow-up period of 44 months (median, 30 months; range, 3-234 months), 92% (n = 1,206) were alive, and 108 (8%) patients died because of RB. Based on Kaplan-Meier analysis, the survival at 1, 3, 5, and 10 years was 94%, 91%, 90%, and 89%, respectively. The most common presenting signs of RB in Asian Indian population are leukocoria and proptosis. With appropriate treatment, the survival rate is favorable at 92%.

Karakteristik pasien ocular surface squamous neoplasia di Pusat Mata Nasional RS Mata Cicendo periode Januari 2012- Juni 2014

&#x0D; &#x0D; &#x0D; Background: Ocular surface squamous neoplasia (OSSN) is a broad term encompassing conjunctival intraepithelial neoplastic lesions (CIN) and invasive squamous cell carcinoma (SCC) of conjunctiva and cornea. The purpose of this study is to describe the demographic, clinical, therapy and histopathology characteristics of OSSNs patients in Cicendo Eye Center within period of January 2012 – June 2014. Methods: Patient medical records were reviewed. Fourty patients of biopsy-proven OSSN at Cicendo Eye Centre from January 2012 until June 2014 were reviewed. &#x0D; Results: Data was collected from 40 patients (41 eyes), OSSN was more frequent in men (62.5%) and had unilateral presentation (97.5%). The mean patient age was 45.9±14.7 years. The most common complaint was lump on the ocular surface (50%). The size of lesion was mostly less than 2 mm (62.5%). All of the patients were managed with surgery using wide excision and histopathology examination, of whom 46.4% cases were managed with wide excision only, 41.4% cases were managed with wide excision and application of topical mitomycin C (MMC), 12.2% cases were managed with wide excision, application of topical MMC, and cryotherapy. Histopathology examination revealed that 41.5% cases were CIN, 19.5% cases were carcinoma in situ, and 39% cases were invasive SCC. &#x0D; Conclusions: Patients with OSSN who came to Cicendo Eye Center were mostly male and had unilateral presentation. The most common clinical sign and symptom were ocular surface mass with size of the lesion less than 2 mm. Management of patient with OSSN is mostly excisional surgery only. Majority of histopathology examination showed CIN. &#x0D; &#x0D; &#x0D;

Unilateral and Atypical Presentation of Vogt-Koyanagi-Harada Syndrome: A Case Report

Unilateral and Atypical Presentation of Vogt-Koyanagi-Harada Syndrome: A Case Report

Isolated Unilateral Symptomatic Pleural Effusion-An Atypical Presentation of Ovarian Hyper Stimulation Syndrome-A Case Report

An uncommon presentation of Ovarian Hyper stimulationSyndrome is Isolated pleural Effusion. Reporting a case of late onset of ovarianhyper stimulationwith Unilateral Pleural Effusion and Respiratory distress as a sole manifestationafter Embryo transfer

Should Spinal MRI Be Routinely Performed in Patients With Clinically Isolated Optic Neuritis?

Should Spinal MRI Be Routinely Performed in Patients With Clinically Isolated Optic Neuritis?

Prevention Medicine in Bilateral Phaeochromocytoma

Background: Adrenalectomy is standard of care for phaeochromocytomas, but for bilateral phaeochromocytoma, the recommendations are inconsistent. However, large studies systematically investigating long-term outcomes for total adrenalectomies compared to those for patients with adrenal-sparing operations are lacking. Methods: A multi-center consortium-based registry was established to study clinical, genetic and surgical data in 623 patients with bilateral phaeochromocytomas. Findings: Of 623 patients, median age at diagnosis was 30 (range 3-79) years and 48% were female. Synchronous bilateral phaeochromocytomas were diagnosed in 396 patients and metachronousphaeochromocytomas in 227 (36%); interval to second operations were up to 40 (median 6) years. In 96% of tested patients germline mutations were detected in the genes RET (56%), VHL (34%), and others (10%). Of 849 operations, 385 (45%) surgeries in 326 patients were planned as adrenal-sparing which was successful in 251. 372 patients became steroid-dependent. Follow-up was up to 53 (median 11) years. Adrenal crises developed in 67 patients (18%) during follow-up, and 49 (13%) had manifestations of iatrogenic Cushing syndrome. Of the steroid-independent patients, 34 (14%) had developed another phaeochromocytoma within the remnant adrenal after up to 27, median 8 years, all treated with removal of the new phaeochromocytoma. Overall survival was mainly influenced by non-phaeochromocytoma comorbidities, whereas only 1% died of metastatic phaeochromocytoma. Cortical-sparing operations did not affect survival. Interpretation: Cortical-sparing operations avert lifelong steroid-dependency without affecting survival. Preoperative genetic testing is recommended even in unilateral phaeochromocytoma presentations to identify patients at heritable risk, to guide surgical approach, and inform for gene-specific extra-adrenal morbidities. Funding Statement: Supported in part by the grant AZV 16-32665A to Sarka Dvorakova and Petr Vlcek, and the Blank Foundation to Charis Eng. Declaration of Interests: None of the authors have relevant conflicts of interest. Ethics Approval Statement: The institutional review boards for human subjects’ protection or ethical committees of all participating centers approved this study. Patients provided written informed consent according to the protocols of respective institutional review boards. In The Netherlands data were collected anonymously, and no further Institutional Review Board approval is required.

Pediatric Bilateral Facial Paralysis

Pediatric bilateral facial nerve paralysis (FNP) is a rare condition, representing less than 2% of all cases of FNP. The differential diagnosis of FNP is extensive (ranging from infectious, traumatic, neurologic, to idiopathic) and often can present as a diagnostic challenge. In contrast to unilateral presentation, bilateral FNP presents as a manifestation of serious systemic conditions, including meningitis (infectious and neoplastic), brain stem encephalitis, Guillain-Barre syndrome, sarcoidosis, Lyme disease, human immunodeficiency virus infection, leukemia, and vasculitis. In the evaluation of a child who presents with bilateral FNP, history plays the utmost role in the diagnosis. A history of rash consistent with erythema chronicum migrans, recent tick exposure, or travel to a Lyme disease-endemic area is highly suggestive that the facial paralysis is a result of Lyme disease. It is also important to recognize that Lyme disease is emerging as the most common infectious etiology of bilateral FNP in the pediatric population. In this case report, we describe a 16-year-old boy who presented to the emergency department with complaints of headache and bilateral FNP, an unusual presentation of Lyme disease.

Hemispheric asymmetries and emotions: Evidence from effective connectivity

The Right Hemisphere Hypothesis (RHH) posits that the right hemisphere is specialized in processing all emotions; the Valence Hypothesis (VH) suggests a left/right-hemispheric specialization for positive/negative emotions, respectively. Behavioural, neuroimaging and physiological investigations alternatively support either the RHH or the VH, but connectivity analyses have been hardly exploited in this field. In the present study, unilateral and bilateral presentations of positive (happy) and negative (angry) emotional faces were used during electroencephalographic (EEG) recordings, and estimation of effective connectivity was performed using the Directed Transfer Function, to estimate causal influences between brain regions (Granger causality approach). The results show a strong pattern of connectivity among different frontal areas (orbitofrontal and dorsolateral prefrontal cortex), attentional network (frontal eye field, intraparietal sulcus), visual occipital areas and temporal sites, mainly lateralized in the right hemisphere for all emotions, in accordance with the RHH. Moreover, a stronger pattern of connectivity is evident when stimuli are presented in accordance with the VH (positive/negative emotions to the left/right hemisphere, respectively). Finally, the results suggest a crucial role of the right dorsolateral prefrontal cortex in a top-down regulation toward different areas involved in emotional processing. We conclude that the RHH and the VH are not mutually exclusive, but they seem to coexist during affective perception.

Clinico-radiological features and treatment outcomes in children with traumatic orbital subperiosteal hematoma

To study the clinical findings, imaging features, and treatment outcomes in children diagnosed with traumatic orbital subperiosteal hematoma (OSpH). The medical records of eligible OSpH children treated either via needle aspiration or open surgical drainage were reviewed retrospectively. Three anatomical factors (inferior globe displacement, superior orbital sulcus fullness, extraocular movements) and two functional parameters (visual acuity, pupillary reactions) were used to determine overall success. A total of 10 children (mean age, 6.8years; 8 males) were included. All had a history of blunt trauma, unilateral presentation, inferior globe displacement, fullness of superior orbital sulcus, and raised retrobulbar resistance. Diminution of vision and restricted elevation was noted in 7 children, and 4 had a relative afferent pupillary defect. Computed tomography (CT) revealed superior OSpH in all 10 children and, additionally, orbital wall fracture in 4. Needle aspiration of the OSpH was performed in 8 children; 2 underwent open surgical drainage. At a mean follow-up of 8.5months, all children showed satisfactory improvement in both anatomical and functional parameters:1 child had a persistent nebulomacular corneal opacity, and 1 had minimal upper eyelid edema. A high index of suspicion, appropriate radiology (CT of orbits), and early management through needle aspiration of OSpH may help in early and satisfactory anatomical and functional outcomes.

Tibial plateau morphology in dogs with cranial cruciate ligament insufficiency.

To identify possible biomechanical causes for the predominantly unilateral presentation of cranial cruciate ligament (CCL) insufficiency by comparing the computed tomographic (CT) features of the tibial plateau of CCL affected and contralateral sound stifles in dogs with unilateral CCL insufficiency. Cross-sectional study. Eighteen dogs, 36 stifles. Eighteen dogs with naturally occurring unilateral CCL insufficiency were included. Stifle CT and radiographs were performed at the time of diagnosis. Follow-up was performed at a minimum of 1 year from the original diagnosis to ensure that there was no evidence of contralateral CCL insufficiency. The medial tibial plateau angle (m-TPA), lateral TPA (and l-TPA), medial tibial plateau midsagittal radius of curvature (m-TPr), and lateral TPr (l-TPr) were measured from the CT images. Variables were compared with paired t tests. A Bonferroni correction was performed, and P < .006 was considered significant. Mean m-TPr was steeper (P = .002) and m-TPr:l-TPr ratio was greater (P < .001) in affected stifles compared with contralateral sound stifles. No other variables differed between groups. Mean l-TPA was steeper than mean m-TPA (P < .001). Tibial plateau convexity differed between the CCL affected and contralateral sound stifle in dogs with unilateral CCL insufficiency. Medial tibial plateau convexity may play a role in the development of CCL insufficiency.

Surgical findings and clinical outcome after bilateral repair of apparently unilateral perineal hernias in dogs.

To report the short- and long-term outcomes and recurrence rate in dogs treated for apparently unilateral perineal hernia with bilateral herniorrhaphy, castration, colopexy, vas deferens pexy with or without cystopexy in single-stage procedures. Thirty-one client-owned dogs with apparently unilateral perineal hernia were included. Perineal hernias were repaired bilaterally, incorporating internal obturator muscle transposition and the sacro-tuberal ligament, combined with colopexy, vas deferens pexy with or without cystopexy. Preoperative pattern of defaecation, pattern of micturition and rectal alignment were recorded. Surgical time, bilateral surgical perineal findings, postoperative complications, short-, middle- and long-term (>24 months) scores and recurrence rate were documented. A hernia with ectopic tissue and weakness of the pelvic diaphragm was identified bilaterally in all dogs despite the unilateral clinical presentation. The procedure combination was achieved uneventfully in all dogs in 56 to 113 minutes (mean 73 minutes). Complication rate was low, consisting mostly of urinary disorders, most of which resolved within a few days. In all, 93% of dogs were free of clinical signs related to perineal hernia at long-term follow-up (mean 27 months). Recurrence rate was 0%. Our surgical findings suggest that perineal hernia in dogs might be considered a bilateral disease, even when the presentation is of apparently unilateral signs. Recurrence is rare following bilateral herniorrhaphy combined with colopexy and deferens pexy with or without cystopexy.

Long-term outcomes of labial mucosal graft in conjunctivo-rhinostomy surgery

ObjectiveTo report the long-term outcomes of the conjunctivo-rhinostomy surgery with labial mucosal graft performed for the patients of proximal lacrimal drainage system disorders. MethodsRetrospective, single surgeon (KB), non-comparative study including patients having complete obstruction of the superior and inferior proximal lacrimal drainage system. All patients underwent conjunctivo-rhinostomy with labial mucosal graft insertion. Preoperatively, tear film break-up time and a fluorescein dye disappearance test was performed for each patient. A phaco aspiration tubing segment was used for supporting the mucosal graft for first 4 weeks followed by its removal. Minimum follow-up was 12 months. fluorescein dye disappearance test and nasal endoscopy were performed at each follow-up visit. Total resolution of epiphora and negative fluorescein dye disappearance test was defined as complete success. ResultsEighteen patients (12 males, 6 females) with a mean age of 39.94 years (range 7–76 years) all had a unilateral presentation. The indication for surgery was trauma (n = 11), failed dacryocystorhinostomy (DCR) with canalicular obstruction (n = 4), chronic ocular inflammation with complete punctal occlusion (n = 2), and post-radiotherapy (n = 1). At a mean follow-up of 5.38 years, complete success was observed in 12 (66.67%), partial success in 4 (22.22%) while in 2 (11.11%) patients, the procedure failed. ConclusionLabial mucosal graft in conjunctivo-rhinostomy is a successful adjunct which provides satisfactory long-term outcomes. Our surgical technique of directly suturing the mucosal graft to surrounding muscle provides better functionality to the system with eyelid blinking.

Disentangling the interaction of sex differences and hemispheric specialization for face processing – Evidence from ERPs

Recent studies on face processing and its hemispheric lateralization suggest that inconsistencies in earlier findings might be partially explained by sex differences, as findings from event-related potential studies indicated a more asymmetric functioning of the visual cortex during face encoding in men, whereas women seemed to display a more bilateral activation pattern. The aim of this study was to further investigate the role of sex differences in hemispheric specialization during face recognition. Fifty-four healthy participants (27 females and 27 males) engaged in a familiarity decision task in which famous and unfamiliar faces were presented in a lateralized tachistoscopic fashion with unilateral und bilateral presentation modes and measurement of event-related potentials and behavioral responses. Results showed a clear N170 component for males and females in all experimental conditions. No hemispheric differences of the N170 were observed in the bilateral condition and both groups showed larger right-hemispheric than left-hemispheric N170 amplitudes in the left visual field condition. In the right visual field condition, however, only female participants showed significantly larger left-hemispheric compared to right-hemispheric N170 amplitudes, whereas male participants did not show such a modulation. The effect corresponds to a greater responsivity of left-hemispheric processes underlying the N170 component in female participants. Further analyses revealed N170 differences in the left and right hemisphere for females only, when stimuli were presented unilaterally. In contrast, this modulation of N170 amplitudes was only observed in the left hemisphere in males. The results suggest a stronger hemispheric lateralization in men than in women during face processing.

Fungal Suppurative Otitis Media (Histopathology) Among Patients in North India.

Chronic suppurative otitis media (CSOM) has a substantial worldwide prevalence and is a major cause of hearing impairment. In cases of CSOM unresponsive to local antibiotics, superimposed fungal infection should be suspected. The aim of the present study was to study the spectrum of cases with fungal otitis media. The study was conducted over a period of 12years (2006-2017). Fifteen cases of CSOM clinically not suspected to be of fungal etiology that underwent surgery with identification of fungal organisms on histopathology were included in the study. Age of the patients ranged from 12 to 75years (mean age: 37.1 ± 22.7years). Of 15 cases, 9 (60.0%) were males and 6 (40.0%) were females. It was a unilateral presentation in all. The complaints observed were ear discharge in all followed by itching (86.7%), pain (46.7%), decreased hearing (26.7%) and blocking sensation (13.3%). Histomorphologic typing of fungus was possible in 13/15 patients. Isolated aspergillus was identified in eight patients while mucor alone was seen in three patients. Mixed infection with Aspergillus + Candida and Aspergillus + Mucor was seen in one patient each. Categorization of fungus could not be done in rest of the two patients due to paucity of fungal profiles. Histopathological identification of fungal organisms in otomycosis provides a quick and fairly reliable diagnosis. Culture is considered the gold standard but it may not always be available or fruitful. Less turnaround time and accurate diagnosis facilitates prompt and optimal therapy in fungal otitis media thus preventing adverse outcomes.