Introduction: Cholesteatoma is an aggressive disease and its management poses a greater challenge in children than in adults. This study reviews the experience of Universiti Kebangsaan Malaysia Medical Centre in the clinical presentation and management outcome of acquired cholesteatoma in paediatrics that required surgical interventions. Materials and Methods: A retrospective review of case records of patients below 18 years old who underwent surgery from 1999 to 2010. Results: A total of 46 patients presented with 53 cases of cholesteatoma in which seven patients had bilateral disease. The age of presentation ranged from four to 18 years old with a mean age of 12 years. Male and female patients were 65% and 35% respectively. Otorrhoea or previous history of otorrhoea on presentation was found in 94% and 96% of them had hearing impairment. Cerebellopontine angle abscess, sigmoid sinus thrombosis and mastoiditis were among the complications. Tympanic membrane was retracted in 64% while 47% having had attic retraction and 53% had total atelectasis. A majority (85%) underwent canal wall down surgery with or without tympanoplasty. Post-operatively, 71% had improvement or preserved hearing level. The duration of follow up ranged from one month to 13 years and a quarter had recurrent disease and underwent revision surgeries. Conclusion: Majority of the cholesteatoma patients suffered from hearing loss and otorrhoea. Tympanic membrane retraction remained the most common clinical finding. Hence, children with persistent otorrhoea after adequate treatment may represent cholesteatoma. Surgical options of canal wall up and canal wall down procedures have equal risk of recurrence.
Cholesteatoma ; Hearing Loss ; Recurrence

Abstract An epsilometer-test method was used to determine MIC values of several antibiotics against 29 Helicobacter pylori isolated from gastric antrum of dyspepsia patients. Isolates with resistance towards antibiotics were 6.9% -65.5% but these were tetracycline-sensitive. Eight isolates showed multi-resistance towards two antimicrobial agents. The high resistance strains towards metronidazole is alarming.

Good collateral circulation flow is a promising outcome for ischemic stroke patients. Collateral circulation is the vessels that flow in parallel to each other, perfusing the same target tissue. Different patients are shown to have different statuses of collateral. Good collateral circulation is expected to give significantly better clinical outcomes for stroke patients including acute stroke patients who underwent thrombectomy. Modern multimodal imaging techniques have encouraged neuroradiology to assess collateral flow. This paper presents the basic overview of CBCT technology and compares the usefulness of Cone Beam Computed Tomography (CBCT), Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) based on working principles, performance, cost and applications. In addition, the overview of collateral circulation and its characteristics will be discussed. In assessing collateral circulation, improvement of acquisition techniques and algorithm CBCT provides fast delineation of detail vasculature and improves spatial resolution. It is a three-dimensional (3D) imaging modality to investigate collateral flow. For ischemic stroke patients with clinical symptoms, CBCT improves the image quality for the assessment of collateral circulation in the brain. Precise evaluation of collateral circulation from the images will support the decision-making for suitable acute stroke treatment, benefiting both the patient and doctor.