We report two cases of carcinoma in situ in the external auditory canal (EAC), presenting with symptoms such as pain, long-term itching of the ear, easy contact bleeding, canal otorrhea and hearing loss. Otoscopic examination revealed granulation tissue and a greyish-black tumour with irregular surface. The first patient had previously been diagnosed with otitis externa with persistent ear itching for the past three years. The second patient had received tympanoplasty for treatment of chronic otitis media on the right ear ten years ago. The first case was treated with wide excision, whereas the second patient received resection of the skin of the EAC together with its adjacent soft tissue, followed by skin grafting. No tumour recurrence was noted in the fourth and third post-operative year for the first and second patient respectively. We suggest that EAC carcinoma can be detected early and treated.
[Show abstract][Hide abstract] ABSTRACT: We studied the pain control, narcotic side effects, and PCA utilization with intravenous PCA morphine during 24 hours post cesarean section period. Fifty-two consecutive women were included in the study. Each received subarachnoid block with hyperbaric bupivacain with addition of fentanyl. After surgery, the patient received diclofenac suppository and IV-PCA commenced in the recovery room. Severity of pain and sedation was assessed hourly, and maximum pain and sedation scores for each 6-hour period were recorded. Two-third of the patients felt mild to moderate pain during transition from spinal analgesia to IV-PCA. Pain severity steadily improved during four 6-hour periods (p-value <0.001). Highest mean sedation score was noticed during the third six-hour postoperative period. Mean morphine consumption was 50 mg. The ratio between number of time PCA activated and dose received and pain score helped in managing the postoperative pain. Morphine IV-PCA, adequately replaces post cesarean section spinal (bupivacain-fentanyl) analgesia with fewer side effects.
Middle East journal of anaesthesiology 06/2004; 17(5):913-26.
[Show abstract][Hide abstract] ABSTRACT: Squamous papilloma is a benign exophytic proliferation which can occur occasionally in the external ear canal. It is widely assumed that the Human Papilloma Virus (HPV) is an etiologic factor of papillomas. Available techniques for detection of HPV genomes include immunohistochemistry, Southern blot hybridization, in situ hybridization (ISH), and polymerase chain reaction. To our knowledge, HPV typing has not been reported on tissue sections of papillomas in the external ear canal. We report HPV ISH analysis in ten cases of papillomas, involving the external ear canal in Chinese patients. These papilloma excrescences were less than 1 cm in diameter, and were benign morphologically. Automated HPV ISH analysis was performed for the hybridization of DNA probes, including both low-risk and high-risk HPV subtypes. HPV ISH results revealed that seven out of ten cases were positive for low-risk HPV (6, 11), three cases demonstrated no hybridization for low-risk HPV probe, and none of the cases revealed any detection of high-risk HPV (16, 18, 31, 33, 35, 39, 51, 52, 56, 58, and 66). On follow-up after 18-29 months (average 24.5 months), eight patients were doing well, with no local recurrence after excision. Two patients were lost to follow-up. Our results confirm that benign papillomas of the external ear canal are associated with low-risk HPV infection with benign behavior and neither recurrence nor high grade dysplasia.
Head and Neck Pathology 09/2009; 3(3):207-11. DOI:10.1007/s12105-009-0131-4
[Show abstract][Hide abstract] ABSTRACT: BackgroundEar squamous cell carcinoma (SCC) is a tumor with a poor prognosis, due to a late initial diagnosis because of a concealment
by primarily benign symptoms and due to the unfavorable localization including the infiltration of important structures such
as the middle ear, mandibular joint or dura.
Patients and methodsWe retrospectively examined 10 patients, medium age: 63.8 ± 9.3 years between 2002 and 2008 with a histological confirmed
SCC of the external auditory canal. The median follow-up period was 20.5 months (range 7–60 months).
ResultsThe treatment involving surgery, radiotherapy and/or chemotherapy yielded a survival rate of 38.3 ± 11.3 months for T1 and
a survival rate of 17.0 ± 3.0 months for T2–T4 tumors. 3/10 patients at T1 stage are under follow-up, all 7/10 (70%) patients
at T2 and T4 stage did not survive 5 years.
ConclusionThe prognosis for ear SCC primarily depends on early clinical and histopathological diagnostics and requires a sufficient
and standardized staging to determine the therapy involving surgery and radiochemotherapy.
Indian Journal of Otolaryngology and Head & Neck Surgery 12/2009; 61(4):270-274. DOI:10.1007/s12070-009-0081-x · 0.05 Impact Factor
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