Download Nasal Inverted Papilloma with Pituitary Papillary Adenocarcinoma

Nasal Inverted Papilloma with Pituitary Papillary Adenocarcinoma
Tarek S. Jamal, Mohieddin M. Mandura, Kamal J. Daghistani
Abstract
Nasal inverted papilloma is a relatively rare benign tumor. It has a characteristic feature that
the epithelium inverts into the underlying stroma and the lesion is endophytic rather than
exophytic. It is almost exclusively a lateral nasal wall lesion with a male preponderance.
Recurrence rates have been reported to be from 28% to 67% (Norris et al., 1963 * Ridolfi et
al., 1977) and the rates of association with malignancy range from 30 to 32% (Ridolfi et al.,
1977 & Myers et al., 1981). Malignancy transformation of the inverted papilooma to
squamous cell carcinoma is much less common than coexistence of the lesion with
carcinoma.
Pituitary tumors account for approximately 10% of clinically apparent intracranial
neoplasms. These include adenoma, carcinoma, craniophryngioma and metastatic
malignancies. Pituitary carcinoma and metastatic malignancies are very rare compared to
adenomas. Metastatic malignancies arise from primaries in the breast, lungs, prostate, colon
and thyroid.
We present a case of nasal inverted papilloma in association with pituitary adenocarcinoma.
A review of the literature will be presented.
Haaemangioma of the Frontal Sinus: A Case Report
Tarek S. Jamal
Abstract
Haemangioma of the frontal sinus was not reported in the English literature until now. This
paper is reporting the first case of the lobular haemangiona of the right frontal sinus that was
treated by surgical excision. Nine months after surgery, there is no evidence or recurrence
clinically. The literature on this topic was reviewed.
Impact of Consanguinity on Childhood Hearing Impairment
in a Saudi Population
Tarek S. Jamal, Kamal J. Daghistani, Siraj S. Zakzouk
Abstract
To determine the current status of consanguinity among Saudi population and its effect on
childhood hearing impairment. A randomly selected sample of 9,540 Saudi children
representing all socio-economic and demoghraphic groups were selected. A field work was
carried out to enumerate and number the various areas of the provinces of the Kingdom. A
survey team of a social worker, an otolaryngologist, an audiologist, and a nurse completed
the questionnaire form, performed clinical examinations and audiological assessments using
free sound speech, tuning fork test, pure tone audiometry using clinical audiometer Ac30 and
tympanometry using GSI33 and Madsen Zodiac 901. The data were analyzed by x 2 test
using EPI-INFO computer software. A total of 9,540 children below the age of 15 years old
were included. Parents of 19% of the children were first cousins and 28% were either second
cousins or other relatives. The prevalence of hearing impairment was found to be 13%
(0.83% severe, 2.42% moderate, and 9.75% mild). The prevalence of hearing impairment
was significantly higher in children whose parents were either first cousins (16.42%, P <
0.00) or relatives (12.42% P < 0.01) as compared to the children whose parents were not
related (10.38%). Our study clearly demonstrated a high percentage of consanguinity among
the Saudi population and a definite role of consanguinity in the etiology of childhood hearing
impairment. A well planned counseling program to create awareness regarding the adverse
effects of consanguineous marriages is needed to save the population from the disability of
hereditary hearing impairment.
Avoidance of Postoperative Blockage of Ventillation Tubes
Tarek S. Jamal
Abstract
Otitis media is one of the most common diseases and the leading cause of hearing loss in
children. Myringotomy and ventilation tube insertion is the most frequent surgical procedure
in children. Hundreds of studies have addressed the early complications and late sequelae of
ventilation tube insertion, but little has been mentioned about relatively common
postoperative problem – blockage of the ventilation tube.
Attempting to clean a ventilation tube in the clinic in an uncooperative child is difficult and
probably dangerous. Different ear drops have been used to dissolve the obstructing
secretions and/or blood clots, with little success. Unfortunately, it is almost always necessary
to change the tube, thereby subjecting the child to another general anesthesia. The study
describes a simple technique that helps prevent blockage of the ventilation tube.
Adenoids in Adults
Tarek S. Jamal, FRCSI
Abstract
This is a prospective study of one hundred patients (18 – 38 years) with nasal obstruction as
their main complaint. They were investigated clinically to verify the presence of adenoid
enlargement, including nasal endoscopy and plain X-ray to the nasopharynx (soft tissue neck
lateral view). Enlarged adenoids was diagnosed in seven (7%) patients. They were
visualized endoscopically, shown radiologically and confirmed by histopathology.
Adenoidectomy successfully relieved the patient's symptoms without recurrence for the
follow-up period of an average of 18 months. Nasal endoscopic examination should be
included in the diagnostic work-up of nasal disorders. If not available, X-ray to nasopharynx
should be included in the investigation of adult patients with nasal obstruction. The diagnosis
of adenoids enlargement in adults should not be disregarded on account of age only.
Incidence of Hearing Impairment and Occluding Wax in
Saudi Children
Afaf Bamanie, PhD, Farma H. Al-Anazy, KSUF, Tarek S. Jamal, FRCSI
Abstract
Ear wax or cerumen normally forms within, and spontaneously clears from the external
auditory canal (EAC). It is mixtures of secretions from two different gland types
(ceruminous and pilosebeceous) found in the outer one third of the EAC, together with
squamous epithelium, dust and other foreign bodies. Its consistency may be affected by
atmospheric pollution. Under normal conditions wax helps prevent ear infection and keeps
the ear from itching. Cerumen is considered a health problem when the self-cleansing
mechanism of the ear fails causing cerumen impaction. Cerumen, dust and dirt are normally
remove from the EAC with the movements of the jaws in combination with the movements
of the ear cilia.
The presence of wax in small amounts may not be noticed, but if it accumulates in the EAC,
it forms wax plugs. This will make otoscopic examination difficult and may impair hearing.
It may also hinder the diagnosis of acute otitis media (AOM) or otitis media with effusion
(OME).
This study was a part of a national survey of hearing impairment among Saudi children. This
part of the investigation was aimed at screening these children for hearing impairment with
special emphasis on the prevalence of impaired wax among them.
The Effects of Nigella Sativa on Allergic Rhinitis
Wadiah Backer, Emad Khoshak, Tarek S. Jamal, Kamal J. Daghistani
Abstract
Allergic rhinitis represents a global health problem. It is common disease with a worldwide
distribution affection at least 10 – 25 % of the population and its prevalence in increasing. It
affects approximately 10 -20 % of North Americans and between 10 and 15 % of North
Europeans. Perennial rhinitis is probably more common in adults than in children. It can alter
the social life of patients interfering with school performance and work productivity. The
cost of lost productivity and medications can be more than $2 billion. Allergic rhinitis can be
defined as a symptomatic disease of the nose, induced after allergen exposure. It is an IgEmediated hypersensitivity disease of the mucus membranes of the nasal airways
characterized by sneezing, nasal obstruction and rhinorrhea. It is closely associated with
asthma suggesting the concept of "one airway, one disease". Allergic rhinitis is mostly found
in association with exposure to areollergens (house dust, house dust mite, moulds, animal
dander, yeast and pollens). It can be either seasonal or perennial. Perennial rhinitis with
severe seasonal exacerbations is common.
Negella sativa (N.S.) has been reported to have a bronchodilator and spasmolytic action
which could be useful in asthma patients. The volatile oil of N.S. is known to contain
thymoquinone. This has a carbonyl fraction with extremely low toxicity. It shows a dosedependent inhibition of histamine release from rat mast cells. The percent inhibition is
significantly higher when the drug was kept in contact with the cells before antigen challenge
than when the drug was added together with the antigen release. The in vivo protective effect
of nigellone was more evident than in vitro effect. The aim of this study was to find out the
effect of N.S. seeds on the symptomatology of allergic rhinitis comparing it with placebo and
Loratadine.
Allergy Workup in Allergic Rhinitis
Emad A. Koshak, Kamal J. Daghistani, Wadiah S. Backer, Tarek S. Jamal
Abstract
Background: Appropriate medical diagnosis and therapy of allergic rhinitis (AR) necessitate
the identification of an IGE mediated sensitization to allergens.
Objective: To explore the expectrum of allergy investigation in patients with AR.
Settings: King ABdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia.
Methods: This is a prospective cross-sectional study. Forty ne patients with symptoms and
signs compatible with AR examined at the ENT clinic were sequentially included. AR
diagnosis was confirmed at Allergy clinic by a positive reaction to an in-vivo tests: total
peripheral eosinophil count (TPEC), total serum IgE, and specific IgE antibodies to common
inhalant allergens by immuno-CAP system (Phadiatop).
Results: AR confirmed by positive SPT was detected in 30 cases (73%). Their ages ranged
between 16-52 years old (m3n 27 ±9SD), and females constituted 56%. The predominant
allergens were house dust mites (HDMs): Dermatophagoides pteronyssinus 70% and D.
farinae 67%, Cat 33%, Cockroach 33%, Salsola pestifer 23%, and Aspergilus 20%. TPEC
ranged 50 – 1210 cell/mm3 (mean=299 ±295SD), and eosinophilia (?450 cells/mm3) was
found in 23%. Toral IgE ranged 8 – 2000 IU/ml (mean = 354 ±452SD, and was elevated (>
190 IU/ml) in 53%. Phadiatop was positive in 83% of AR cases. A very significant
correlation between SPT and Phadiatop (df=1, P<0.001) was found.
Conclusion: Sensitization to inhalant allergens, particularly HDMs, by both in-vivo (SPT)
and in-vitro (Phadiatop) methods was common in AR cases in Jeddah. The presence of
eosinophilia and/or high total IgE in the context of compatible clinical findings may be
helpful in establishing the diagnosis of AR. This work advocates the importance of allergy
workup for allergen sensitization in both AR diagnosis and the subsequent care of patines by
promoting avoidance strategies.
Keynotes: Allergic rhinitis, Eosinophilia, IgE, Phadiatop, Skin pric test.
Comparison between endoscopic nasal examination, plin
X-ray and CT scan in the diagnosis of sinus pathology
Tarek S. Jamal, Kamal J. Daghistani, Mohammed M. Rawas and Tarek R. Saleh
Abstract
Nasal endoscopy, plain X-ray and CT scan are used selectively or in combination in the
diagnosis of sinus disease. Each has a variable degree of accuracy and limitation. In this
study, 120 patients with nasal sinus-related symptoms were subjected to routine ear, nose
and throat (ENT) examination including nasal endoscopy, plain x-ray and CT scan of the
paranasal sinuses. The clinical diagnosis of sinusitis was established on rhinoscopic
examination in 22 patients (27%), nasal endoscopy showed anatomical or pathological
abnormalities in 72 patients (60%), plain x-ray revealed positive findings in 92 patients
(77%), and CT showed anatomical abnormalities or mucosal sinus disease in 94 patients
(78%). Nasal endoscopy could reveal hidden anatomical or pathological abnormalities in
cases with normal anterior rhinoscopic examination. Plain x-ray still has a significant role in
screening patients with suspected sinus disease. Any patient with positive plain x-ray
findings, even with negative nasal endoscopic examination results, should be subjected to
CT scan of the paranasal sinuses, which will accurately delineate the site, extent and cause of
the disease. It is suggested that simple mucosal thickening in the maxillary and/or anterior
ethmoids is not necessarily diagnostic or sinusitis unless it is associated with osteomeatal
region with normal anterior ethmoid cells. This proves that the anterior ethmoid may not be
the primary site of infection of the maxillary sinus, at least in some cases.