Ten laryngopharyngectomy specimens were dissected to determine the relative accuracy of computed tomography (CT) and endoscopy under anesthesia for evaluating the inferior extent of pyriform sinus carcinoma. Endoscopic examination failed to detect involvement of the pyriform sinus apex in one patient, and considerably underestimated disease at this level in two others; CT accurately predicted the status of the apex in these three and all other patients. Endoscopy underestimated the inferior extent of tumor in six patients; CT revealed the inferior limit relative to the esophageal verge more accurately in all six of these submucosal extensions. Endoscopy revealed one case of mucosal spread to the esophageal verge not demonstrated by CT. Endoscopy and CT were both correct in revealing the esophageal verge to be involved (one case) and free of disease (two cases). This study also confirmed a common tendency of pyriform fossa cancer to spread through thyrohyoid membrane adjacent to the course of superior laryngeal neurovascular bundle (six cases). High-resolution CT, in experienced hands, is a useful adjunct to endoscopy for detecting submucosal, inferior extension of pyriform sinus carcinoma. This information can influence the choice of the lower margin of resection and method of pharyngeal reconstruction.

The spread pattern of 14 cases of primary subglottic cancer, as seen on computed tomography (CT), is analyzed. Cricoid cartilage invasion was present in nine cases. Tracheal invasion was definite in four cases and questionable in three. Extralaryngeal soft tissue spread was present in nine cases; all but one had cartilage destruction. The patterns of spread seen accurately reflect reports in previous whole-organ section studies, and suggest that the elastic cone has a primary role in directing the spread of tumor. Anticipating spread to areas described above with CT and/or magnetic resonance imaging (MRI) can be used to try to improve treatment planning and perhaps outcome by: (1) avoiding placement of urgent tracheostomies close to the tumor; (2) helping to modify standard surgical approaches by suggesting lower-than-usual tracheostomies, or more extensive-than-usual thyroid gland resection; and (3) avoiding delay in diagnosis by strongly suggesting rebiopsy when imaging indicates a tumor is present, and initial endoscopy and biopsy cannot confirm the imaging findings.

The spread pattern of 14 cases of primary subglottic cancer, as seen on computed tomography (CT), is analyzed. Cricoid cartilage invasion was present in nine cases. Tracheal invasion was definite in four cases and questionable in three. Extralaryngeal soft tissue spread was present in nine cases; all but one had cartilage destruction. The patterns of spread seen accurately reflect reports in previous whole-organ section studies, and suggest that the elastic cone has a primary role in directing the spread of tumor. Anticipating spread to areas described above with CT and/or magnetic resonance imaging (MRI) can be used to try to improve treatment planning and perhaps outcome by: (1) avoiding placement of urgent tracheostomies close to the tumor; (2) helping to modify standard surgical approaches by suggesting lower-than-usual tracheostomies, or more extensive-than-usual thyroid gland resection; and (3) avoiding delay in diagnosis by strongly suggesting rebiopsy when imaging indicates a tumor is present, and initial endoscopy and biopsy cannot confirm the imaging findings.

PURPOSE: To compare the efficacy and safety outcomes of bimanual microincision cataract surgery (MICS) versus 2.2-mm coaxial phacoemulsification assisted by Femtosecond LenSx (Alcon-LenSx Inc., Aliso Viejo, CA). METHODS: This prospective, randomized, observational, comparative case series comprised 50 cataractous eyes of 50 patients receiving femtosecond laser refractive lens surgery followed by a bimanual MICS technique with two 1-mm incisions (25 patients) (FemtoMICS group) and a coaxial phacoemulsification technique with a 1-mm paracentesis and a 2.2-mm principal incision (25 patients) (FemtoCoaxial group). The main outcomes measures were: ultrasound power, effective phacoemulsification time, postoperative spherical equivalent, higher-order aberrations (corneal and internal), corneal thickness, endothelial cell count, macular thickness, and complications during and after surgery. Both groups were absolutely comparable for all variables preoperatively. RESULTS: Mean ultrasound power was 1.8% ± 0.9% for MICS and 14.7% ± 4.9% for 2.2-mm incisions (P .001). Effective phacoemulsification time values for MICS and 2.2-mm incisions were 1.5 ± 0.9 and 4.5 ± 2.9 sec, respectively (P = .002). Mean postoperative spherical equivalent was -0.26 for FemtoMICS and -0.33 for FemtoCoaxial (P > .05). The efficacy index at 1 month postoperatively was 160.2% for FemtoMICS and 149% for FemtoCoaxial. No significant differences were found in corneal thickness, endothelial cell count, and macular thickness. Complications included posterior capsule rupture (4%) and anterior capsule rupture with no posterior capsule tear (4%) for FemtoMICS and bridges due to incomplete capsulorhexis (4%) for FemtoCoaxial. CONCLUSIONS: MICS and coaxial phacoemulsification techniques assisted by the Femtosecond LenSx achieved excellent safety and efficient outcomes. The FemtoMICS technique was surgically and statistically more efficient than the FemtoCoaxial technique.

Background: Clostridium difficile is an important pathogen associated with outbreaks of diarrhea and other intestinal disorders, such as pseudomembraneous colitis. Methods: 95 pediatric patients suffering from diarrhea and 37 adult patients from Assiut University Hospital were included in this study. Stool samples were collected from each patient and were subjected to direct toxin immunoassay and culture on cycloserine/cefoxitin/fructose agar for 72hrs. Clostridium difficile isolates were confirmed by the use of API® strips. DNA was extracted from all Clostridium difficile isolates and stool samples and the presence of tcdA and tcdB (Toxin) genes were tested by the use of polymerase chain reaction. We compared the results of the toxin immunoassay and the direct detection of toxin genes with culture of C. difficile. Results: Clostridium difficile strains were isolated from 17 (17.9 %) pediatric and 10 (27 %) adult fecal samples and all the isolates were confirmed to contain tcdA and tcdB genes that are associated with toxin production “toxigenic culture”. Considering the toxigenic culture as the “gold standard”, the sensitivities, specificities, positive and negative predictive values, and accuracies of the assays , respectively, were 100%, 89.7%, 68%, 100%, 91.6% for toxin A immunoassay in pediatric samples; 82.4%, 100%, 100%, 96.1%, and 96.7% for the direct PCR in pediatric samples; 100%, 96.3%, 90.9%, 100%, and 97.3% for toxin A immunoassay in adult samples; and 100%, 100%, 100%, 100%, and 100% the direct PCR in adult samples. Conclusion: Our findings indicate that direct detection of toxin genes in stool sample is considered a sensitive and specific method for detection of diagnosis C. difficile.