In our study, there was no association identified between LD placement and recurrence rates after endoscopic repair of CSF rhinorrhea.

Background Post-viral olfactory dysfunction is a common cause of both short- and long-term smell alteration. The coronavirus pandemic further highlights the importance of post-viral olfactory dysfunction. Currently, a comprehensive review of the neural mechanism underpinning post-viral olfactory dysfunction is lacking. Objectives To synthesize the existing primary literature related to olfactory dysfunction secondary to viral infection, detail the underlying pathophysiological mechanisms, highlight relevance for the current COVID-19 pandemic, and identify high impact areas of future research. Methods PubMed and Embase were searched to identify studies reporting primary scientific data on post-viral olfactory dysfunction. Results were supplemented by manual searches. Studies were categorized into animal and human studies for final analysis and summary. Results A total of 38 animal studies and 7 human studies met inclusion criteria and were analyzed. There was significant variability in study design, experimental model, and outcome measured. Viral effects on the olfactory system varies significantly based on viral substrain but generally include damage or alteration in components of the olfactory epithelium and/or the olfactory bulb. Conclusions The mechanism of post-viral olfactory dysfunction is highly complex, virus-dependent, and involves a combination of insults at multiple levels of the olfactory pathway. This will have important implications for future diagnostic and therapeutic developments for patients infected with COVID-19.

Background Intrathecal fluorescein (IF) has become a common tool for localization of cerebrospinal fluid (CSF) leak, but despite frequent use, IF lacks Food and Drug Administration approval. The diagnostic ability of high-resolution computed tomography (HRCT) has increased over several decades. Subspecialized rhinology training within otolaryngology has, similarly, allowed for dedicated skull base surgeons to become more adept at CSF leak localization. Objectives To evaluate the utility of HRCT and IF in CSF leak localization. To identify certain patient populations in which IF has added utility. To analyze the ability of fellowship-trained neuroradiologist and rhinologist to localize CSF leak sites. Methods Data were collected from a single, tertiary care academic institution. Patients admitted for CSF leak between 2003 and 2016 were included. Diagnostic yield of preoperative imaging and IF for identification of leak site was analyzed. Fellowship-trained neuroradiologist and rhinologist performed retrospective review of CT imaging and identified CSF leak sites. Results One hundred and two patients underwent CSF leak repair. Skull base defects were preoperatively localized to exact sinus on imaging report in 67% of patients. Preoperative imaging stratified by CT slice thickness of 0.625 mm identified leak site in 88.9% of cases. Blinded retrospective review by a neuroradiologist and rhinologist was able to localize the CSF leak to the correct or adjacent sinus in >80% of cases. IF was useful for intraoperative localization in 73% of cases. When preoperative imaging failed at leak site localization, IF was able to correctly identify leak site in 75% of cases. Conclusions The diagnostic yield of IF and CT imaging was equivalent, with each modality localizing leak site approximately two-thirds of the time. CT imaging with 0.625 mm slice thickness proved more efficacious in identification of skull base defects. IF demonstrated increased utility in instances where preoperative imaging has failed at leak site identification.

Superior mesenteric artery (SMA) injury is a rare event during abdominal surgery. We report the first case of inadvertent injury of the superior mesenteric artery during surgery of a large malignant adrenocortical tumor with inferior vena cava thrombus. The cause of inadvertent injury was anatomical distortion of the great vessels due to the massive nature of the tumor. The case was managed successfully by immediate end-to-end anastomosis of the superior mesenteric artery.

Tuberculosis is the leading cause of chronic granulomatous epididymo-orchitis in the Asian population. A retrospective analysis of 40 patients diagnosed with granulomatous or tubercular epididymo-orchitis on fine-needle aspiration (FNA) was carried out. May Grünwald giemsa, haematoxylin and eosin and Ziehl Neelsen stained smears were evaluated. Of 40 patients studied, aspiration smears showed epithelioid cell granulomas with caseation in 17, granulomas alone in 19 and caseation only in four. Acid fast bacilli were seen in 15. Cytologic diagnoses rendered were tubercular epididymo-orchitis in 15, granulomatous inflammation suggestive of tuberculosis in six and granulomatous inflammation in 19. FNA may readily diagnose tubercular epididymo-orchitis and may avoid unnecessary orchidectomy in a good number of patients.