Oncocytoma Parotid Gland

Very few cases of parotid oncocytoma have been reported in literature. Because of its rarity (<1% of salivary gland tumors) and clinical presentation of the tumor, there is a tendency among the clinicians to misdiagnose it as pleomorphic adenoma, hemangioma, or other forms of oncocytosis. Only a histopathological examination can confirm it. We evaluate here a case of swelling of the parotid gland in a 70-year-old male who had the tumor for over 9 years to reach a diagnosis. Furthermore, our aim is to bring to the forefront how these lesions require a comprehensive workup and how to choose the best treatment strategy.

Morphometric analysis of human cricoid cartilage: a cadaveric study

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Cricoid cartilage is the only complete ring that surrounds the airway completely. Although it is smaller than thyroid cartilage and does not house any important structures like the thyroid cartilage (vocal folds), it forms an important cog in the upper airway. Renewed interest in subglottic stenosis recently has underscored the importance of detailed knowledge of cricoid cartilage. This study aims to augment the meagre information available on this important part of upper airway. </span></p><p class="abstract"><strong>Methods:</strong> Study design was on morphometric analysis and the setting was at tertiary health care centre. <span lang="EN-IN">Thirty one adult human cadaveric larynges were obtained for this study. Using an electronic vernier caliper, different morphometric parameters of all the cricoid cartilages were noted down in a predesigned proforma in standard computer office software. The data thus obtained was collated and compared with existing literature.  </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">The average inner transverse diameter (F: 15.05±1.02 mm; M: 17.52±2.64 mm) is greater than the average inner antero-posterior diameter (F: 12.71±0.45 mm; M: 14.11±2.55 mm). The average height of cricoid arch was F: 6.50±0.68 mm; M: 7.69±0.63 mm and the average height of cricoid lamina was F: 18.38±0.61 mm; M: 21.17±2.31 mm. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Inter specimen<strong> </strong>disparity was noted in the various dimensions measured in the cricoid cartilages. The average transverse diameter was greater than the average antero-posterior diameter giving the cartilage an ovoid shape in nearly all specimens. Morphometrical data of the cricoid cartilage may be very useful in endotracheal intubation, laryngeal microsurgery and laryngeal framework surgery. These parameters can be helpful in evaluation of subglottic stenosis and its surgical repair.</span></p><p> </p>

Noise Induced Hearing Loss with Tinnitus: Does TRT Help?

Introduction To determine if hearing augmentation and tinnitus retraining therapy (TRT) helps in cases of Tinnitus with Noise induced hearing loss (NIHL) and does degree of hearing loss, severity or duration of tinnitus affect recovery  Materials and Methods A prospective study was done on 100 patients of NIHL with tinnitus from Jan 14-Jul 15. Degree of hearing loss was assessed. Tinnitus severity was scored on Tinnitus handicap inventory (THI) scale as Slight, Mild, Moderate, severe or catastrophic and patients were subjected to TRT. Patients scored after 1 year of TRT. A relation between tinnitus severity, duration and degree of hearing loss on recovery from tinnitus was analysed. Result 62 of the 100 patients improved following TRT. Discussion In 100 patients THI scores improved from a mean of 63.12 (SD-21.12) to 38.16 (SD-18.21). Mean difference between pre and post-intervention THI scores was 24.96 (SD-17.97). Improvement was significant in severe or profound hearing loss (P<.001). Tinnitus severity was slight, mild, moderate, severe or catastrophic on THI. Following TRT, 82.35% with Catastrophic, 70.96% with severe, 52.63% with moderate, 20% with mild tinnitus improved. 1 patient with slight tinnitus did not improve. Based on duration of tinnitus three groups made; 0-6 months, 6-12 months and >12 months. All groups showed improvement. Reduction in Post-TRT THI was significant but did not show any difference among groups. Conclusion TRT helps in tinnitus with NIHL particularly if hearing loss is severe. Severe or catastrophic tinnitus patients experience greater improvement. Duration of tinnitus has no impact.

Bilateral Asymmetrical Fracture Dislocation of Shoulder with Rare Combination of Injuries after Epileptic Seizure: A Case Report

The incidence of bilateral gleno-humeral joint dislocation is rare, is almost always posterior and is usually caused by sports injuries, epileptic seizures, electrical shock, or electroconvulsive therapy. Bilateral fracture-dislocation is even rarer, with a few cases reported in the literature. We report an unusual case with dislocation of the both glenohumeral joints in opposite direction after a seizure episode, with fracture of greater tuberosity on one side and of the lesser tuberosity on the contralateral side. Although there have been a few reports of bilateral asymmetric fracture dislocations of the shoulder in the past, an injury pattern resembling our case has, to the best of our knowledge, not been described in the literature so far. This report includes a detailed discussion regarding the mechanism of injury in a case of asymmetrical dislocation following a seizure episode. At final follow-up, the patient had healed fractures, painless near normal range of motion with no redislocations.

Sentinel lymph node localization using 1 % isosulfan blue dye in cases of early oral cavity and oropharyngeal squamous cell carcinoma

To study the use of 1 % isosulfan blue dye in identifying sentinel node, sensitivity and specificity of frozen section and predictive value of sentinel node in predicting other nodal status in the cases of oral cavity and oropharyngeal squamous cell carcinoma. 15 patients of oral cavity and oropharyngeal SCC with clinically N0 neck, who required WLE of the primary lesion as well as neck dissection as per recommended treatment protocol, were selected from OPD. 1 % Isosulfan dye was injected peritumorally intraoperatively after the induction of general anaesthesia. Neck dissection was performed and first node taking up the blue dye was identified, dissected, removed and was sent for frozen section. In two of the 15 cases a sentinel node was identified (sensitivity of the technique-13 %). Both the sentinel nodes were positive for presence of metastasis on final histopathology (specificity-100 %). However, five cases had nodal metastasis on final histopathological examination of the neck dissection specimen (sensitivity of sentinel lymph node biopsy-40 %). Frozen section examination had a sensitivity and specificity of 100 %. All data was analyzed using SPSS 16 software. Use of 1 % Isosulfan Dye for identification of sentinel node is a simple and cheap technique, however, it has low sensitivity as compared to the use of triple diagnostic procedure consisting of lymphoscintigraphy, per op gamma probe localization and using isosulfan dye for sentinel node identification. Sentinel lymph node is representative of nodal status and correlates well with the final histopathological examination of the dissected neck nodes.

Effect of early skin-to-skin contact following normal delivery on incidence of hypothermia in neonates more than 1800 g: randomized control trial

OBJECTIVE

To investigate the impact of early skin-to-skin contact (SSC) provided for first 24 h on incidence of hypothermia in stable newborns weighing 1800 g or more during first 48 h of life.

STUDY DESIGN

Stable newborns (term and late preterm: Mean gestational age 37.7 (1.35) weeks, range 34-40 weeks) having birth weight 1800 g or more (Mean weight 2605.6 (419.8) grams) were enrolled after approval from Institutional Human Research Ethics Committee (CTRI/2013/06/003790) and randomized into early SSC (intervention group) and conventional care (control group). Initial care in the delivery room for few minutes immediately after birth in both the groups was given under radiant warmer. In the intervention group, newborns were provided SSC by their mother started between 30 min and 1 h after birth for first 24 h with minimal interruption and were provided conventional care other than SSC for next 24 h of life. In the control group, newborns were kept with their mother and received conventional care other than SSC for first 48 h. Temperature and heart rate of newborns were recorded at 30 min, 1, 2, 3, 4, 5, 6, 12, 24 and at 48 h of life in both the groups. Independent Samples t-Test and relative risk were used to analyze the data.

RESULT

Both groups had 50 neonates each with similar baseline characteristics. Heart rates were in normal range in both the groups. The intervention group provided an average (s.d.) of 16.98 (0.28) h of SSC over the first 24 h period. The mean temperature was significantly high in the SSC group at all time intervals starting from 1 to 48 h (P<0.05 for all). In the SSC group only two newborns (4%) had mild hypothermia (cold stress), and, of these two newborns, one had two episodes of hypothermia. All these three episodes of hypothermia occurred within first 3 h of life. In the control group 16 newborns (32%) developed hypothermia (temperature<36.5 °C) during first 48 h of life. Of them, 11 newborns had single episode, 4 newborns had two episodes and one newborn had three episodes of hypothermia. Of these 22 hypothermic episodes, 20 occurred in the first 6 h of life and 2 episodes occurred at 48 h of life. Moderate hypothermia was seen in two newborns, whereas rest had mild hypothermia. The relative risk of developing hypothermia in the control group as compared with the SSC group was 8.00 (95% CI 1.94-32.99). There was no seasonal variation in incidence of hypothermia in both the groups.

CONCLUSION

Newborns in the SSC group achieved rapid thermal control as compared with the control group. Early SSC for 24 h after birth decreases incidence of hypothermia for initial 48 h of life. Early SSC needs to be aggressively promoted in term and late-preterm newborns to reduce incidence of hypothermia.