KTP-532 Laser Assisted Excision of a Rare Laryngeal Angiolipoma: A Case Report with Review of Literature

Angiolipoma is a benign mesenchymal tumor and its occurrence in head and neck region is very rare. Only 2 cases of Laryngeal angiolipomas have been reported in the medical literature. We present one such rare case in a 32-year-old male who presented with complaints of change in voice and foreign body sensation in the throat since past 9 months along with features suggestive of obstructive sleep apnoea and dysphagia. Contrast enhanced CT scan of the neck showed a cystic lesion arising from right ventricle extending superiorly till the vallecula, partially obstructing the airway. Suspecting a supraglottic cyst, trans-oral microlaryngoscopic KTP-532 laser assisted excision was planned, intraoperatively a solid tumor was encountered. We discuss herein the clinical presentation and management of this rare neoplasm with review of literature.

Correlation Between Nasal Allergy and the Number of Eosinophils in Adenoid Tissue

To study adenoid tissue eosinophilia in allergic rhinitis. A single-centre clinical case-control prospective study with 66 subjects enrolled for the study after taking written informed consent from all the participants. All patients underwent adenoidectomy with histopathological evaluation of adenoid tissue samples for eosinophils. 36 patients (cases) with Symptoms for Allergic Rhinitis (SFAR) score indicative of allergic rhinitis. 30 patients (control) with SFAR scores not indicative of allergic rhinitis. All patients were evaluated for serum absolute eosinophil count and total serum immunoglobulin E (Ig-E). There was a significant relationship between allergic rhinitis and serum Ig-E levels using the Kruskal-Wallis rank sum test amongst case and control groups with a p-value of 0.031. Pathologically examined slides of adenoid tissue eosinophil count per 10 random high power fields in these patients showed significant results with a p-value of 0.002432, via the Kruskal-Wallis rank sum test. Statistical analysis, shows that adenoid tissue eosinophil count and serum Ig-E levels can somewhat predict the presence of clinical features of allergic rhinitis. Based on several similar studies with similar results, allergic rhinitis can be gauged with adenoid tissue histopathology and routine evaluation should be considered as a standard of care.

KTP 532 Laser Assisted Surgery for Oral Cavity Malignancy-A Retrospective Study

Aims and Objective

To determine the effectiveness of KTP 532 in surgically treating early and early advanced oral malignancy with no surgical reconstruction of primary site.

Materials and methods

It is a retrospective study of 67 cases operated between 2000 to 2013 including T1, T2 and Early T3 cases, approved by ethical committee. All the cases underwent Laser assisted excision of tumour with or without Neck Dissection or Adjuvant Radiotherapy. Age of the cases varied from 20 to 80 years with mean age of 49 years. 47 cases were males and 20 were females. 26 cases in the study had neck nodes clinically whereas 41 cases had N0 status. Neck dissection was done (SOND or MRND) in 61 cases. In 6 cases (N0) no neck dissection was done.

Results

61 cases had no loco-regional residual disease on their last follow up. Six cases had loco-regional recurrence within 6 months and salvage surgery was done. The overall mean survival was 81 months (92, 82 and 71 months in Stage I, II,III respectively). 3 year disease free survival rate was 91% as calculated using Kaplan- Meier Scale. In all these cases tumour was excised with KTP 532 laser and no reconstruction was done. Wound was allowed to heal with secondary intention.

Conclusion

Laser assisted excision of oral malignancy is an alternative to conventional treatment with more precision, less morbidity, shorter hospital stay and better functional outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-022-03214-x.

Nasal Mucociliary Clearance in Prolonged Tracheostomy Patients: A Prospective Case-Control Study

Prolonged tracheostomy bypasses the upper airways leading to absence or reduction of nasal airflow. This altered nasal physiology not only impairs olfaction but also may cause mucociliary dysfunction and consequent nasal crusting and rhinosinusitis.To objectively evaluate the extent of nasal mucociliary impairment in patients with prolonged duration of tracheostomy.This is a prospective case-control study done in a tertiary care center wherein the nasal mucocilary function was assessed by saccharin test in patients who were tracheostomized for a period of more than 4 weeks and the saccharin transit time (time taken to appreciate the sweet taste after endoscopic insertion of saccharin pellet on anterior end of inferior turbinate) was compared by the same test in age and sex matched healthy individuals. The saccharin transit time in the two groups was statistically analyzed using student t-test. Mean saccharin transit time in 30 patients with prolonged tracheostomy was 934.97 s with a standard deviation of 75.95 s whereas in 30 controls, the meantime was 447.4 s with a standard deviation of 63.22 s, which was statistically significant (p < 0.001). Conclusion Prolonged duration of tracheostomy leads to impaired nasal mucociliary clearance, which in turn could cause chronic rhinosinusitis.

Intracranial Complications due to Chronic Suppurative Otitis Media-Atticoantral Disease with a Reference to its Microbiological Profile: A Retrospective Study

Introduction: Intracranial Complications (ICC) in patients with Chronic Suppurative Otitis Media-Atticoantral Disease (CSOMAAD) is a life threatening disease. Knowing the microbiological profile of the causative organisms will help in selecting empiric antibiotic. Aim: To determine the demographic pattern and clinical presentation of patients with CSOM-AAD presenting with ICC, and to assess the microbiological profile of causative organisms. Materials and Methods: This was a retrospective study, where medical records of all patients diagnosed with CSOM-AAD and ICC, in a tertiary teaching hospital, Manipal, Karnataka, India, between July 2012 and June 2018 were reviewed. The data regarding demographics, clinical and audiological evaluation, microbiological reports were analysed. Data was entered into Microsoft Excel sheet 2010 and was calculated as mean, median and percentages. Results: Out of total 244 patients with CSOM-AAD, 15 presented with ICC. The age range was between 17 to 41 years (median age-21years). The most common complaint was headache, n=11 (73%) and the most common complication was intracranial abscess, n=10 (67%). In three cases, sampling from different sites isolated different organisms and hence a total of 20 samples (11 from ear swab, six from abscess drained pus, two from cerebrospinal fluid and one from blood culture) were analysed. Gram Negative Bacilli (GNB) were isolated most of the times, n=10 (50%) followed by Gram Positive Cocci (GPC), n=6 (30%) and anaerobes, n=2 (10%). Most of the isolated GNB and GPC were susceptible to carbapenem and vancomycin, respectively. Conclusion: Intracranial complications are usually seen in young adults, and they present with headache, fever and ear discharge. Majority of the complications are caused by GNB. Vancomycin and carbapenem provide empiric cover for GPC and GNB, respectively

Pathological response and clinical outcomes in operable triple-negative breast cancer with cisplatin added to standard neoadjuvant chemotherapy

BACKGROUND

Response to neoadjuvant chemotherapy is associated with improved outcomes for patients with triple negative breast cancer (TNBC). Patients with residual disease are at increased risk of relapse and death from breast cancer. In this retrospective study, we aimed to evaluate the efficacy and safety of cisplatin added to standard neoadjuvant chemotherapy for locally advanced TNBC.

MATERIALS AND METHODS

All TNBC treated with neoadjuvant cisplatin 60mg/m2 once in 3 weeks with weekly paclitaxel for 12 weeks, following 8 weeks of dose-dense epirubicin 90mg/m2 or doxorubicin 60mg/m2 with cyclophosphamide 600mg/m2 were analyzed retrospectively. The data related to pathological complete response, adherence to planned therapy, disease-free survival and overall survival were collected.

RESULTS

Eighty-three patients were included, of whom 80% had stage III disease. Pathological complete response in both breast (T0/Tis) and axilla (N0) was observed in 48.1% of patients. Miller Payne grade 5 pathological response in the breast was seen in 61% of patients. Good partial responses (Miller Payne grades 3,4) were observed in 32.5% of patients. The remaining 6.5% were poor responders. Seventy-seven patients underwent surgery. The disease-free survival at 1 and 3 years for those who had a pathological complete response was 96.7% and 77.6%, respectively, and 92.3% and 62.7% for those who did not, respectively. The predominant adverse events were hematological, with anemia being the most common one.

CONCLUSION

The addition of cisplatin to neoadjuvant chemotherapy with anthracycline and taxane in TNBC was tolerable and produced a high rate of pathological complete response. Cisplatin added to standard chemotherapy in patients with locally advanced TNBC could improve clinical outcomes.

Prevalence of Body Dysmorphic Disorder among patients seeking orthodontic treatment

Background

Body Dysmorphic Disorder (BDD) is a psychiatric disorder with delusions about defects in appearance for which patients seek various treatments. Patients with BDD often seek cosmetic procedures, and orthodontic treatment is one among them. This is the first Indian study to determine the prevalence of BDD in an orthodontic outpatient department.

Materials and method

A total of 1184 patients with varying degrees of malocclusion completed the BDD-YBOCS questionnaire, while an experienced orthodontist assessed the severity of malocclusion with a rating scale.

Results

Sixty-two patients (5.2%) were screened positive for BDD. Most of the BDD-positive patients were single (p value of 0.02) and had multiple previous consultations for orthodontic treatment (p value of < 0.00**) with a gender predilection toward males (p value of 0.00**), and age was not statistically significant with a p value of 0.3.

Conclusion

From our study, the prevalence of BDD among orthodontic patients was 5.2%. The orthodontist should be aware of the high prevalence of BDD among orthodontic patients and identify the expectations of the patient at the time of history taking and refer the patient to a psychiatrist for diagnosis and appropriate management.

Coronavirus disease - COVID-19: new perceptives towards epidemic to pandemic

The sudden outbreak and uncontrolled spread of the novel coronavirus disease 2019 (COVID-19) has shocked the world to a degree never seen before. Due to the wide spread transmission of the virus, the number of infected cases worldwide has surpassed 16,421,958 and global death toll has spiked up to 6,52,308 from December 2019 to 27 July 2020. The virus has been labelled as a pandemic by the WHO. Virologists have found that this virus outbreak is similar to past outbreaks of viruses such as severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East Respiratory Syndrome that caused severe respiratory syndrome and transmitted rapidly in humans. These single stranded RNA viruses come under the genera of β-coronaviruses which ultimately infect lungs and respiratory tract. Even though the origin, source and intermediate hosts of this virus is unknown, transmittance from human-to-human through various paths has been identified globally. As of today, there are no approved drugs and vaccines. Several clinical trials are being conducted today to evaluate vaccines against the virus. The aim of our present review is to furnish brief details about the statistics, diagnosis, epidemiology, pathogenesis, prevention and treatment of COVID-19 to assist researchers and the society at large to come to grip with the deadly disease.HighlightsCumbersome outbreak of the novel Coronavirus Disease 2019 (COVID-19) became a pandemicAt June 19, 2020, as per WHO report 8,618,787 infected cases and 457,275 dead were recorded globallyMajor spread was found to be human to human transmissionsPeople with positive COVID-19 were infected with severe respiratory syndromeMore animal and clinical studies have to be done to overcome this pandemic.

Abstract A42: Total laryngopharyngoesophagectomy with gastric transposition for hypopharyngeal cancer: A tertiary care center experience

Introduction: With the emergence of organ preservation protocol in head and neck cancer, management of hypopharyngeal carcinoma is generally by nonsurgical approach; however, a significant number of hypopharyngeal cancer patients present in advanced stage and exhibit poor prognosis. For such cases, thorough aggressive surgical excision of laryngopharyngoesophageal complex with appropriate reconstruction might be a viable option.

Objective: To evaluate quality-of-life measures and survival outcomes in hypopharyngeal carcinoma cases undergoing above-mentioned procedure at a tertiary health care center.

Methodology: A retrospective study on patients with hypopharyngeal carcinoma undergoing above-mentioned procedure was done in our tertiary care institute between September 2016 to October 2018.

Results: A total of 12 patients were operated during the study period; however, 3 patients were excluded due to inadequate data. In our study, mean age of presentation was 51.3 years and majority were men (n=8). Most of the patients at the time of presentation were stage IVA or more. Postcricoid was most common subsite, followed by pyriform fossa. 4 out of 12 were operated after failed chemoradiation. Perioperative morbidity primarily in terms of complications and duration of hospital stay and quality-of-life measures consisting mainly of swallowing score were analyzed, which suggested that this procedure is tolerable and produces a reliable outcome.

Conclusion: Total laryngopharyngoesophagectomy with gastric transposition is a feasible and efficacious treatment option with reasonable quality of life in carcinoma hypopharynx patients, especially after failed chemoradiation.

Citation Format: Prerit Rao, K. Devaraja, Kailesh Pujary, Dipak Ranjan Nayak, R. Balakrishnan. Total laryngopharyngoesophagectomy with gastric transposition for hypopharyngeal cancer: A tertiary care center experience [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Optimizing Survival and Quality of Life through Basic, Clinical, and Translational Research; 2019 Apr 29-30; Austin, TX. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(12_Suppl_2):Abstract nr A42.

Correlation Between Microbiological Profiles of Adenoid Tissue and Nasal Discharge in Children with Co-existent Chronic Adenoiditis and Chronic Rhinosinusitis

Chronic adenoiditis leading to adenoid hypertrophy is common in children. Many cases would also have co-existing chronic rhinosinusitis (CRS). Infact, long lasting bacterial infection of the adenoids has been hypothesized to be the cause for CRS in these children. A cross-sectional study was conducted in the departments of ENT and Micro-biology at Kasturba Hospital, Manipal, India between 2016 and 2017. 20 subjects who were diagnosed with CRS and adenoid hypertrophy took part in the study. Aerobic, anaerobic and fungal culture sensitivity of adenoid tissue was done along with aerobic and fungal culture sensitivity of nasal swabs from middle meatus. 2 out of 20 adenoid samples showed positive culture for aerobes and 19 adenoid samples grew anaerobic organisms. 7 out of 20 nasal swabs grew some aerobes and 2 were positive for fungal organisms. The correlation of microorganisms between adenoid hypertrophy and CRS was seen only in one patient in which methicillin resistant Staphylococcus aureus was grown. The present study showed mixed flora in the adenoid samples with anaerobic predominance. Aerobes were predominantly grown in nasal swabs from patients with CRS along with fungal colonizers. Though the study does not establish any bacteriological association with the CRS in our cohorts, the significant growth of the anaerobes from the core of the inflamed adenoids has prompted us to suggest the inclusion of the antibiotics against the anaerobes in the medical management of these children, whenever feasible. We think the addition of specific antibiotics to tackle anaerobes helps by hampering the further inflammatory hypertrophy of adenoid tissue.

Ethnic Variation of Sinonasal Anatomy on CT Scan and Volumetric Analysis

To determine Ethnic differences in the frequency of the relatively common anatomical variants along with difference in anatomy of sinonasal region with surgical importance. A study was conducted to determine the frequency of anatomical variants, volumes of paranasal sinuses using computed tomography and to identify any difference between Group A consisting of people of Indian subcontinent and Group B consisting of people from north east Asian region. Volumetric analysis done using cumulative of area multiplied by slice thickness. The results were compared using Chi square test, p value < 0.05 was considered statistically significant. Among the common and uncommon anatomical variants (Agger nasi, pneumatized uncinate, concha bullosa etc.) there was no significant difference between the two groups. In both the groups Keros Type 1 was the most common type of ethmoid roof seen. On volumetric analysis sphenoid sinus volume was found to be higher in Indians without mongoloid features. Hence it's ideal that in this era of endoscopic sinus surgery we tailor make approaches to address individual anatomical variation.

Application and Evaluation of Independent Component Analysis Methods to Generalized Seizure Disorder Activities Exhibited in the Brain

EEG records the spontaneous electrical activity of the brain using multiple electrodes placed on the scalp, and it provides a wealth of information related to the functions of brain. Nevertheless, the signals from the electrodes cannot be directly applied to a diagnostic tool like brain mapping as they undergo a "mixing" process because of the volume conduction effect in the scalp. A pervasive problem in neuroscience is determining which regions of the brain are active, given voltage measurements at the scalp. Because of which, there has been a surge of interest among the biosignal processing community to investigate the process of mixing and unmixing to identify the underlying active sources. According to the assumptions of independent component analysis (ICA) algorithms, the resultant mixture obtained from the scalp can be closely approximated by a linear combination of the "actual" EEG signals emanating from the underlying sources of electrical activity in the brain. As a consequence, using these well-known ICA techniques in preprocessing of the EEG signals prior to clinical applications could result in development of diagnostic tool like quantitative EEG which in turn can assist the neurologists to gain noninvasive access to patient-specific cortical activity, which helps in treating neuropathologies like seizure disorders. The popular and proven ICA schemes mentioned in various literature and applications were selected (which includes Infomax, JADE, and SOBI) and applied on generalized seizure disorder samples using EEGLAB toolbox in MATLAB environment to see their usefulness in source separations; and they were validated by the expert neurologist for clinical relevance in terms of pathologies on brain functionalities. The performance of Infomax method was found to be superior when compared with other ICA schemes applied on EEG and it has been established based on the validations carried by expert neurologist for generalized seizure and its clinical correlation. The results are encouraging for furthering the studies in the direction of developing useful brain mapping tools using ICA methods.

Range-based ICA using a nonsmooth quasi-newton optimizer for electroencephalographic source localization in focal epilepsy

Independent component analysis (ICA) aims at separating a multivariate signal into independent nongaussian signals by optimizing a contrast function with no knowledge on the mixing mechanism. Despite the availability of a constellation of contrast functions, a Hartley-entropy-based ICA contrast endowed with the discriminacy property makes it an appealing choice as it guarantees the absence of mixing local optima. Fueled by an outstanding source separation performance of this contrast function in practical instances, a succession of optimization techniques has recently been adopted to solve the ICA problem. Nevertheless, the nondifferentiability of the considered contrast restricts the choice of the optimizer to the class of derivative-free methods. On the contrary, this letter concerns a Riemannian quasi-Newton scheme involving an explicit expression for the gradient to optimize the contrast function that is differentiable almost everywhere. Furthermore, the inexact line search insisting on the weak Wolfe condition and a terminating criterion befitting the partly smooth function optimization have been generalized to manifold settings, leaving the previous results intact. The investigations with diversified images and the electroencephalographic (EEG) data acquired from 45 focal epileptic subjects demonstrate the efficacy of our approach in terms of computational savings and reliable EEG source localization, respectively. Additional experimental results are available in the online supplement.

Combating nasal septum deviation in le fort 1 orthognathic surgery complications, with submental intubation

INTRODUCTION

Orthognathic Le Fort 1 osteotomy, a surgical procedure performed to correct the aesthetics of mid face. Some of the complications of this surgery are hemorrhage, loss of sensation due to facial nerve damage, nasal septum deviation leading to crooked nose and snoring. Nasal septum deviation is the most common complication and one of the most noticeable complications that is developed during the Le Fort 1 osteotomy.

AIM

To ascertain that Submental Intubation in Orthognathic Le Fort 1 Osteotomy combats Nasal septum Deviation.

MATERIALS AND METHODS

Medical records and clinical data of 32 patients who underwent orthognathic Le Fort 1 Osteotomy under submental orotracheal intubation were analyzed to understand if nasal septum deviation and other complications of Le Fort 1 Osteotomy occurred in such cases based on 6 parameters.

RESULTS

No complications of nasal septum deviation or other complications that's associated with orthognathic Le Fort 1 Osteotomy were found in the 32 cases that were analyzed.

DISCUSSION

The surgeon needs to have a non-obtrusive nasal canal so as to determine the extent to which the nasal septum needs to be reduced so that it does not cause nasal septum deviation post the procedure. Submental oratracheal intubation provides the surgeon with an excellent view of the operating field, enough space for intra oral manipulation of the bone and septum for intra oral operation and control of dental occlusion.

CONCLUSION

Submental intubation is a better method of intubation during Le Fort 1 osteotomy as it does not cause nasal septum deviation or other associated complications.

"Herbal remedy is natural and safe"--truth or myth?

Neem oil is often used externally as a traditional medicine in India. Its ingestion, even in small doses produces toxic effects like severe metabolic acidosis, seizures, renal failure and encephalopathy. Management is supportive and prognosis is generally good but fatalities may occur. Herein we report an unusual case of neem oil toxicity in a previously normal adult.

A comparison of microdebrider assisted endoscopic sinus surgery and conventional endoscopic sinus surgery for nasal polypi

Nasal polyposis is often encountered in rhinology practice. Those who fail conservative management, a definitive surgery is essential to achieve sufficient ventilation and drainage of the affected sinuses by using either microdebrider or conventional instruments for functional endoscopic sinus surgery (FESS). A prospective study was conducted on 40 cases of nasal polypi in a tertiary care hospital. 20 cases were operated by conventional endoscopic instruments and 20 using the microdebrider. The study aimed at comparing the intra operative (blood loss, duration of surgery) and post operative results (crusting, scarring, discharge, symptoms, recurrence) between the two groups using Lund-Mackay scoring system and the data was statistically analysed. There was no statistically significant difference in surgical outcome for patients when either conventional endoscopic instruments or microdebrider was used. However, there was a significant symptomatic improvement in cases undergoing microdebrider FESS. Microdebrider assisted polypectomy is precise, relatively bloodless surgery though the precision depends on the surgeon's anatomical knowledge and operative skills. Study substantiates that these instruments are helpful but not a prerequisite for successful outcomes in FESS. The study re-emphasises the utility of the microdebrider to young learning FESS surgeons.

KTP Laser in Laryngeal Amyloidosis: Five Cases with Review of Literature

To study the clinical presentation and review the options in the management of laryngeal amyloidosis. To study the efficacy of KTP 532 laser in the excision of laryngeal amyloidosis. Study was conducted in our department in a tertiary care hospital between Jan 2001 and Feb 2010. We report five patients who presented with hoarseness of voice and localized laryngeal lesions. The biopsy proven laryngeal amyloidosis lesions were excised microendoscopically using KTP 532 laser in three patients and other two patients were kept only on follow-up as they refused further surgery. The patients were evaluated for systemic amyloidosis. The average duration of follow up was 2.6 years (3 months 6 years). All the five patients in our study were asymptomatic with no evidence of recurrence at their last follow up. In our small case series, KTP 532 laser excision of the laryngeal amyloidosis had a favorable outcome. Long term follow up is required to rule out recurrence and systemic involvement.

Evaluation of protective action of α-tocopherol in chromium-induced oxidative stress in female reproductive system of rats

The present study was aimed to investigate whether α-tocopherol could protect the chromium (Cr) VI-induced oxidative stress in female reproductive system of rats and to explore the underlying mechanisms of the same. A total of 24 Wistar adult female rats were equally divided into four groups. Group 1 served as control, while groups 2 and 3 were administered K2Cr2O7 (10 mg/kg b.wt. s.c. single dose). In addition to Cr, group 3 also received α-tocopherol @ 125 mg/kg daily by oral gavage for 14 days. Group 4 was maintained as α-tocopherol control (dose as above). Body weights were recorded at the beginning and at the end of experiment. Further, the rats were observed for occurrence of estrus cycle. At the end of 14 days, blood samples were drawn for sero-biochemical analysis. Subsequently, all the rats were sacrificed to collect uterus along with ovaries for assay of tissue peroxidation, anti-oxidant and functional markers, and histopathology. Administration of chromium (Cr) VI to rats revealed a significant (P < 0.05) accumulation of cholesterol and a prolonged diestrus phase leading to impaired fertility in rats. Administration of chromium (Cr) VI significantly (P < 0.05) reduced the antioxidant markers such as superoxide dismutase (SOD) and reduced glutathione (GSH), along with significant (P < 0.05) increase in peroxidation markers such as malondialdehyde and protein carbonyls in ovaries. The functional marker in serum such as total protein was decreased, whereas other functional markers viz alanine transaminase (ALT), blood urea nitrogen (BUN) and creatinine were increased. Prominent pathological changes were observed in the uterus and ovaries of Cr-treated group. Co-treatment with α-tocopherol significantly (P < 0.05) reversed the (Cr) VI induced changes.

Facilitating Discourse Analysis with Interactive Visualization

A discourse parser is a natural language processing system which can represent the organization of a document based on a rhetorical structure tree-one of the key data structures enabling applications such as text summarization, question answering and dialogue generation. Computational linguistics researchers currently rely on manually exploring and comparing the discourse structures to get intuitions for improving parsing algorithms. In this paper, we present DAViewer, an interactive visualization system for assisting computational linguistics researchers to explore, compare, evaluate and annotate the results of discourse parsers. An iterative user-centered design process with domain experts was conducted in the development of DAViewer. We report the results of an informal formative study of the system to better understand how the proposed visualization and interaction techniques are used in the real research environment.

Functional anatomy of the uncinate process and its role in endoscopic sinus surgery

BACKGROUND

A basic step of Functional Endoscopic sinus surgery-the most modern and revolutionary surgical treatment for chronic and recurring sinusitis, is removal of uncinate process to expose the infundibulum. The purpose of this study is to explore the functional role of uncinate process with special reference to endoscopic sinus surgery.

METHODS

A fixed dose of sterile methylene blue was sprayed into the nasal cavities of post endoscopic sinus surgery cases, 20 without uncinate process preservation and 20 with uncinate process preservation. The area of staining/deposition of the stain in the ethmoidal cavity and the maxillary sinuses was endoscopically observed.

RESULTS

Deposition of methylene blue was consistently found to be occurring in a larger area of the ethmoidal cavity including the maxillary sinus in post endoscopic sinus surgery cases without uncinate process preservation.

CONCLUSION

Uncinate proces probably acts as a protective wall by directing the allergen bearing and contuminated inspired air away from the sinuses and facilitating ventilation of the sinuses in the mucocilliary pretreated expiratory phase. Injudictious removal of the uncinate process especially in cases with allergic rhinosinusitis should thus expose the sinus mucosa to contaminated air.

Solitary extramedullary plasmacytoma of the sinonasal region

Less than 10% of the patients with plasma cell neoplasms present with a solitary plasmacytoma. Though the nasal cavity is a common extramedullary site, the occurrence is extremely rare. Two cases of solitary extramedullary plasmacytoma of the sinonasal region are reported. The first of which is sinonasal plasmacytoma with concomitant HIV, an association that has been reported rarely in literature to date and is matter of much debate. In the second case report, we present an instance of surgical excision of the tumor using KTP 532 laser. The diagnosis was established using immunohistochemical techniques and multiple myeloma workups were negative in all cases.

The burden of smoking-related ill health in the UK

BACKGROUND

Smoking is one of the biggest avoidable causes of morbidity and mortality in the United Kingdom. This paper quantifies the current health and economic burden of smoking in the UK. It provides comparisons with previous studies of the burden of smoking in the UK and with the costs for other chronic disease risk factors.

METHODS

A systematic literature review to identify previous estimates of National Health Service costs attributable to smoking was undertaken. Information from the World Health Organization's Global Burden of Disease Project and routinely collected mortality data were used to calculate mortality due to smoking in the UK. Population-attributable fractions for smoking-related diseases from the Global Burden of Disease Project were applied to NHS cost data to estimate direct financial costs.

RESULTS

Previous studies estimated that smoking costs the NHS about 1.4 billion to 1.7 billion pound in 1991 and has been responsible for about 100,000 deaths per annum over the past 10 years. This paper estimates that the number of deaths attributable to smoking in 2005 was 109,164 (19% of all deaths, 27% deaths in men and 11% of deaths in women). Smoking was directly responsible for 12% of disability adjusted life years lost in 2002 (15.4% in men; 8.5% in women) and the direct cost to the NHS was 5.2 billion pound in 2005-6.

CONCLUSION

Smoking is still a considerable public health burden in the UK. Accurately establishing the burden in terms of death, disability and financial costs is important for informing national public health policy.

Fourth branchial pouch sinus - an unusually late initial presentation

OBJECTIVE

Here we present an unusual case of a male patient with 4th branchial pouch sinus with an initial presentation of pseudothyroiditis at an unusually late age of 20 years.

METHOD

Case report and a review of the world literature concerning 4th branchial pouch sinus is presented.

RESULT

The patient was diagnosed by radiology and endoscopy and treated surgically. Histopathology revealed chronic inflammatory changes, which pointed towards recurrent sub clinical low-grade inflammations over the years keeping the condition occult till 20 years of age.

CONCLUSION

According to available literature it almost always presents in the first decade of life when it might be misdiagnosed. However our report shows it may also exist with sub clinical inflammations or infections and present at a much later stage in life, when the possibility of such a sinus shouldn't be ruled out on the basis of lack of history of recurrent neck inflammations.

Leiomyoma of the nasal septum

Leiomyoma of nasal cavity is an extremely rare and unusual benign mass that uncommonly arises from the nasal septum. These are vascular or nonvascular masses of myogenic origin. We present a rare case of leiomyoma arising from the nasal septum and discuss its management using KTP 532 laser.

Haemangiopericytoma of the oropharynx

Haemangiopericytoma (HPC) is a rare vascular tumor arising from the pericytes of Zimmermann and is characterized by its unpredictable and variable biological behavior. These tumors are common in the trunk and the extremities and less than 16% of the cases occur in the head & neck region. Its occurrence in the oral cavity and pharynx is uncommon. We report an extremely rare case of haemangiopericytoma of the oropharynx arising from the tonsillo-lingual sulcus as a pedunculated mass, which was successfully excised perorally after a preliminary tracheostomy. No recurrence has been noted on a follow-up of more than six years.

Contact tracing following exposure to measles at a wedding party in the United Kingdom, October 2007

On 22 October 2007, a case of suspected measles in an unvaccinated two-year-old was notified to Thames Valley Health Protection Unit by North East and North Central London Health Protection Unit.

Hyalinizing clear cell carcinoma of the base of tongue

Hyalinizing clear cell carcinoma is a rare, low-grade neoplasm of the minor salivary glands. It is composed exclusively of epithelial cells with optically clear cytoplasm. There are only a few isolated cases reported in the literature involving the base of tongue. The treatment of choice is wide excision and selective neck dissection, with or without radiotherapy. The prognosis of these tumours is good. A 57-year-old male patient presented with a lesion in the base of tongue, which was well enhanced on contrast computerized tomography scan. Once confirmed by biopsy, the hyalinizing clear cell carcinoma was resected via a transcervical approach. The patient underwent postoperative radiotherapy. There was no evidence of locoregional recurrence or distant metastasis at 18 months of follow up.

Germline BRCA1 mutation and survival analysis in familial breast cancer patients in Kerala; South India

Mutations in breast cancer susceptibility gene BRCA1 have been identified in breast or breast/ovarian cancer families from different ethnic background. We analyzed a total of 79 samples for BRCA1 mutation, using Conformation Sensitive Gel Electrophoresis (CSGE) followed by sequencing. The overall survival of BRCA1 mutation carriers was also investigated. BRCA1 mutation was detected in 11 out of the 29 (38%) patients. Four different alterations were detected of three which were novel. A missense mutation in exon 7, 465G>A was detected in 1 patient (9%). Another missense mutation 932 G>A was observed in three patients (27.3%) and a truncation mutation 1027delA, was observed in one patient (9%). The fourth type of mutation (185delAG) which also results in protein truncation was observed in 6 different patients (54.5%). Kaplan-Meier survival analysis revealed a median overall survival of 34 months for BRCA1 mutation positive breast cancer patients and 71 months for BRCA1 negative breast cancer patients. The median overall survival of BRCA1 truncation mutation carriers was 26 months. Our data showed high prevalence of BRCA1 gene mutation among breast or breast/ovarian cancer families in South India and breast cancer patients having BRCA1 mutations were associated with poor prognosis.

Hyperhomocysteinemia presenting as superior mesenteric artery thrombosis

We report a 23-year-old man who presented with acute abdomen. At laparotomy, he was diagnosed to have superior mesenteric artery thrombosis, with consequent extensive intestinal gangrene extending from the proximal jejunum till the mid transverse colon. He subsequently developed dry gangrene of the digits. Further evaluation showed that he had marked hyperhomocysteinemia. The gangrenous bowel was resected, and the homocysteine level normalized with folic acid supplementation. He is well at 1-year follow up. His brother, who was asymptomatic, was also detected to have hyperhomocysteinemia, which responded to folic acid.

Endoscopic KTP-532 laser assisted diverticulotomy for Zenker's diverticulum

Zenker's diverticulum, though counnon in western countries is uncommon in India. This diverticuham is an extension of umcosa through Killian's dehiscence. Various surgical methods have been described for the treatment of this condition including the use of lasers but none in Indian Journals. In this paper we describe a case of Zenker's diverticulum where diverticulotomy using KTP532 laser was successfully performed. Its advantages over other techniques are mentioned.

The Gene Ontology (GO) database and informatics resource

The Gene Ontology (GO) project (http://www. geneontology.org/) provides structured, controlled vocabularies and classifications that cover several domains of molecular and cellular biology and are freely available for community use in the annotation of genes, gene products and sequences. Many model organism databases and genome annotation groups use the GO and contribute their annotation sets to the GO resource. The GO database integrates the vocabularies and contributed annotations and provides full access to this information in several formats. Members of the GO Consortium continually work collectively, involving outside experts as needed, to expand and update the GO vocabularies. The GO Web resource also provides access to extensive documentation about the GO project and links to applications that use GO data for functional analyses.