Posttraumatic septic superior sagittal sinus thrombosis: report of a case.
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Biomedical subjects
Publications and source records attributed to F Tovi.
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A cystic dilatation of a paranasal sinus by an entrapped air mass has been termed pneumosinus dilatans or a pneumocoele. The occurrence of this condition in the maxillary sinus is quite rare. In the present case, a mid-face mass mimicking an osteoma was the presenting sign of the disease. The pathogenesis, clinical features and radiological aspects of this entity are reviewed. In order to avoid confusion with other conditions of different aetiopathogenesis, we propose to label the lesion as 'air cyst' of the paranasal sinus, a term that best describes the nature of the lesion.
A case of giant lateral cervical cystic metastasis from occult thyroid carcinoma mimicking branchial cleft cyst is reported. Lateral cervical cystic metastases arising from occult thyroid carcinoma and their ultrasonic differentiation from true cysts are discussed.
An unusual case of synergistic infection caused by Salmonella paratyphi and anaerobic streptococcus resulting in necrotizing cervical infection associated with deep neck abscess and internal jugular vein thrombosis, is presented. Salmonella acting as an oxygen consumer in the infected tissues, facilitates the growth of anaerobic cocci, hence the development of a devastating soft tissue infection. The precipitating cause was a tonsillar infection developing due to 'post-anginal sepsis'. The aetiopathogenesis of the cervical infection is discussed.
Orbital abscess of rhinosinogenic origin may develop, either by contiguous spread of the infection or by a thrombophlebitic process. While destruction of the bony walls of the paranasal sinus occurs in propagation of the infection by tissue continuity, haematogenous spread may take place through intact bone. Computed tomography demonstrates the status of the bony partitions shared by the orbit and paranasal sinuses, and the source of the orbital sepsis, thereby influencing the therapeutic approach.
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The clinicopathological aspects of 15 patients with necrotizing soft-tissue infections in the head and neck are reviewed. Our relatively large series suggests that the disease occurs more frequently than described in the literature. Histological studies showed that tissue superficial and deep to the fascia is frequently involved with the infectious inflammatory process, even in early stages of the disease. These pathologic changes were also found in healthy-appearing tissues at the periphery of the lesions. The early recognition of the disease and the prompt and aggressive surgical and medical therapeutic approach have resulted in far lower mortality rates (7%) than those reported in the literature. Frozen-section examination contributed to the maximal eradication of the pathologic process. This successful outcome was achieved in spite of the adverse associated clinical conditions, such as old age, debilitating disease, or complications, observed in half of the patients.
While infections of the infratemporal fossa are occasionally documented in the otolaryngologic literature, a recent computer literature search failed to identify any significant series of cases describing this potentially fatal infection. This presentation focuses attention on the joint clinical/imaging experience of 11 cases of infratemporal fossa infection, as seen at the Soroka Medical Center of the Ben Gurion University of the Negev, in Beer-Sheva, Israel, and the Mount Sinai Hospital, of the University of Toronto, in Toronto, Canada. This manuscript reviews our experience, with particular emphasis on the effective role and accuracy of CT scanning in identifying the correct anatomic and pathologic diagnosis, as well as in the planning of treatment.
Sixty-four diverse central nervous system (CNS) complications were noted in a series of 50 patients initially suffering from an otorhinological infection. Thirty-five patients (70%) were in pediatric age groups (1-15 years). Twelve patients (24%) had more than one complication. Mortality rates were 16% in patients with one CNS complication and 25% in patients with multiple complications. Overall mortality rate was 18%. Leptomeningitis was the most common intracranial complication (42%) occurring, mainly in pediatric patients. Lateral sinus thrombosis (LST) was accompanied with other intracranial abnormalities in 72% of the cases. Brain abscess as an initial or concomitant complication was associated with the highest mortality rates (44%). Three of these fatal cases had multiple brain abscess. The rarity of intracranial suppurations secondary to ear and nose infections and the masking effect of the antibiotics bring difficulties in the early detection of CNS complications. Although the modern imaging techniques contribute to the recognition and localization of the intracranial pathology, the clinical investigation is still of paramount importance in detection of the original infection in the pneumatic spaces of the upper respiratory tract.
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Varicella zoster virus (VZV)-specific IgG and IgA antibody titers were determined in serial serum samples of 23 patients with Ramsay Hunt syndrome by the immunoperoxidase assay. Varicella zoster virus-specific IgG antibodies were found in the first serum samples of all the patients. In 80% of 20 patients in whom a serum sample was available within 5 days after the onset of the disease. VZV-specific IgA antibodies were detected. The second serum sample was VZV-specific IgA-positive in all of the patients. While all the healthy age- and sex-matched control subjects had VZV-specific IgG antibodies, VZV-specific IgA antibodies were detected in a low titer (dilution = 2) in only three of the subjects. By using VZV-specific IgA antibody titers greater than or equal to 2 and greater than or equal to 4 by the immunoperoxidase assay as a "cutoff" for younger and older patients with Ramsay Hunt syndrome, respectively, an early diagnosis of the disease can be obtained in 89% of the younger and in 64% of the older patients by a single serum sample.
Adenoid cystic carcinoma of the external auditory canal is much less common than squamous cell carcinoma and basal cell carcinoma. Signs and symptoms of the case presented here consisted of a longstanding discharging ear, a progressive hearing loss, and the presence of a circumferential subcutaneous induration in the distal third of the external auditory canal. No dizziness, tinnitus, or facial weakness was present. Computed tomography showed a soft tissue mass in the external auditory canal and middle ear with no lytic areas of the mastoid or the temporal region. A biopsy specimen was interpreted as an adenoid cystic carcinoma. Treatment consisted of radical excision of the external auditory canal via a modified temporal bone resection. This radical approach resulted in the local eradication of the lesion.
During a 6-year period (June 1982 to June 1988), 100 consecutive total thyroidectomies were performed at Mount Sinai Hospital, University of Toronto, for benign and malignant disease. There were five permanent complications: one deliberate sacrifice of the recurrent laryngeal nerve and four cases of persistent hypoparathyroidism. Four of these five complications occurred in extracapsular carcinoma and resulted from oncologic wide-field resection and/or deliberate sacrifice. One patient with benign disease suffered initially transient hypoparathyroidism which has now become permanent. Interestingly, two patients actually underwent deliberate sacrifice of a recurrent laryngeal nerve; one patient has made a surprising recovery at 16 months postoperative and now has full vocal cord mobility. Our experience suggests that the morbidity of total thyroidectomy relates primarily to the stage of malignancy and extracapsular extension, necessitating en bloc excision accompanied by additional lymph node dissection. The low incidence of permanent complications in benign thyroid disease suggests the feasibility of total thyroidectomy as the operation of choice when surgeons are familiar with the technique and indications.
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A case of thyroglossal duct anomaly showing an unusual finding of foci of cartilage is presented. Although the concept of choristoma may explain the pathogenesis of cartilage within the present congenital anomaly, the histologic features were more in favor of a metaplastic process. In addition, the history of recurrent bouts of local inflammation supports the latter view.
An extensive lateral sinus thrombosis secondary to silent otitis media, in a patient with a nephrotic syndrome, is presented. The thrombotic process progressed asymptomatically until the occlusion of the superior vena cava. Removal of the intractable pathology within the mastoid and administration of appropriate antibiotic therapy, prevented the further propagation of the life-threatening condition.
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