bluuebunny/crossref_metadata_2025 huggingface dataset:
Study of conservative treatment in uncomplicated acute appendicitis
Authors: Gedam B. S. , Gujela Ajit , Bansod Prasad Y. , Akhtar Murtaza
Published: March 2017

Background: Management of acute appendicitis with antibiotics only, without surgery is currently evaluated. Non-operative management of uncomplicated acute diverticulitis and salpingitis has been well established but the non-operative management of acute appendicitis remains controversial. Growing evidence indicates that patients with acute uncomplicated appendicitis can be treated safely with an antibiotics- first approach.Methods: A tertiary care hospital based longitudinal study with duration of 26 month. Patients with clinical and radiological feature of acute appendicitis presenting within 48 hours of initiation of abdominal pain with Modified Alvarado Score ≥5 included. Various demographic, clinico-pathological, radiological factors were studied.Results: 71 patients evaluated, mean age of 30.45±9.71 years. Tenderness in RIF was the commonest finding followed by Fever and rebound tenderness. Leucocytosis seen in 74.65% Modified Alvarado score of 5-6 was present in 18.32% whereas 7-9 was present in 81.68% patients. USG was suggestive of appendicitis in 84.50% patients. Conservative treatment was successful in 74.65% patients with no treatment failure. 25.35% patients, conservative treatment failed. Overall recurrence was seen in 13.11% cases that were successfully managed during primary admission.Conclusions: Majority of cases of first attack of uncomplicated acute appendicitis can be treated successfully by conservative treatment. However, conservative treatment requires monitoring and repeated re-evaluation to identify failure which needs to be treated promptly by surgery. Treatment failure on primary admission as well as the short- term recurrence after conservative treatment is low and acceptable. The outcome of conservative treatment does not depend on Modified Alvarado Score.
Low dose spinal anesthesia for open cholecystectomy: a feasibility and safety study
Authors: Laoutid Jaouad , Sakit Fouad , Jbili Nabil , Hachimi Moulay Ahmed
Published: March 2017

Background: Cholecystectomy is performed either open or a laparascopic route. the traditional and invasive open cholecystectomy is still in frequent practice for various reasons. Spinal anesthesia (SA) has been widely used as alternative to General Anesthesia (GA) for laparoscopic cholecystectomy. SA could be a safe and effective anaesthetic procedure for open cholecystectomy.  This study was conducted to uncover feasibility and safety of low dose SA for conducting open cholecystectomy.Methods: All consented patients of ASA grade I and II of either sex scheduled for elective open cholecystectomy received SA using 2 ml of 0.5% hyperbaric Bupivacaine mixed with 100 µg Morphine. Peri-operative preparations and management were all standardized. Other drugs being only administered to manage anxiety, pain, nausea/vomiting, hypotension, and any adverse event. Open cholecystectomy by right oblique incision. Intra-operative events and post-operative events were observed for 48 hours, operative difficulty, post operative pain free interval, analgesia requirements, hospital stay and the surgeon and patient satisfaction were studied.Results: 20 patients were included in the study from 1st may 2016 to December 2016. Spinal anesthesia was adequate for surgery in all patients. Operative difficulty scores were minimal and surgery in one patient was converted to open cholecystectomy. Intraoperatively, five patients presented hypotension and Ephedrine was given. Four patients experienced pain and received Fentanyl and midazolam. Postoperatively, pain scores were minimal and paracetamol was not sufficient only in four patients who received ketoprofen and no patient received opioid. One patient required antiemetic for vomiting and two patients suffered urinary retention and one headache. 19 patients were discharged within 48 hours of surgery and patient satisfaction scores were very good.Conclusions: Spinal anesthesia is safe and effective anesthetic technic for uncomplicated open cholecystectomy in terms of peri-operative events and, in prolonged post-operative analgesia, as well as in terms of patient and surgeon’s satisfaction.
A study showing efficacy of harmonic scalpel over electrocautery in modified radical mastectomy
Authors: N. Anandaravi B. , Nair Praveen P. , Aslam Mohammed Anwar
Published: March 2017

Background: The dissection in breast surgeries can be done using sharp scalpel and scissor dissection and high frequency electrocautery. Rarely, radiofrequency ablation and laser had been used in some limited trails. This study aims to prove the efficacy of harmonic scalpel over electrocautery in modified radical mastectomy operation.Methods: In this study, we included 40 patients with operable breast cancer. The patients were randomized into two equal groups by closed envelope technique to do modified radical mastectomy either using harmonic scalpel (group A) or using electrocautery (group B). The efficacy of two procedures were compared intraoperatively and postoperatively. The intraoperative parameters used were total time taken for surgery, time taken for axillary dissection, time for raising the flaps and time taken dissection of the breast tissue and the amount of blood loss. The post-operative parameters used were total drainage volume, days of drainage and seroma formation.Results: Our study showed use of harmonic sclalpel in modified radical mastectomy, resulted in reduction in total operating time (t= 4.037, p=0.00) as well as reduction in time taken for axillary dissection (t=3.66, p=0.001) and the amount of blood loss (t=3.02, p=0.00). The total drain volume (t=3.031, p=0.004) and the days of drainage (t=5.97, p=0.00) were also less with the harmonic scalpel dissection as compared to electrocautery.Conclusions: The use of harmonic scalpel in modified radical mastectomy shortens the operating time, axillary dissection time, amount of blood loss and drainage volume and drainage day and hence the hospital stay.
Clinical study and management of pseudocyst of pancreas
Authors: Babu G. Rajashekara , Venkatesh Sahanashree , K. Ramakrishnan , Jain Pravesh
Published: March 2017

Background: Pancreatic pseudocysts can occur as a complication of acute or chronic pancreatitis. Understanding of pseudocysts has changed with times due to advancement in radiology and introduction of new treatment modalities. This study was done to access clinical features etiology and various managements for pseudocyst in a tertiary care hospital.Methods: It is a prospective study of 40 adult patients admitted in Victoria and Bowring and Lady Curzon Hospital, attached to Bangalore Medical College and Research Institute, Karnataka, India from January 2015 to December 2016.Results: Pseudocysts are more common in males. The commonest etiology associated was alcohol. Ultrasound was the basic radiological investigation done in all patients followed by CECT abdomen. Complications associated with pseudocyst were Gastric outlet obstruction and ascites. Internal drainage was done in most of the patients. Post drainage complications included infection which was managed by antibiotics and endoscopic drainage in case of recollection. Pain was most important post-operative complication. Endoscopic drainage is being preferred as it is less invasive, has a high long term success rate, has shorter duration of hospital stay and more patient comfort.Conclusions: Pseudocyst of pancreas is most commonly seen in males probably because of alcoholism. Clinical presentation can be varied, with pain abdomen being the most common complaint followed by, nausea vomiting. Initial management consists of supportive care and if the symptoms persist and complications develop surgical drainage was the most common management modality. Newer modalities of treatments like endoscopic intervention have an added advantage of lesser pain, shorter duration of hospital stay and recurrence.
Prospective randomised study using focus harmonic scalpel versus conventional hemostasis for vessel ligation in open thyroid surgery
Authors: N. Anandaravi B. , Aslam Mohammed Anwar , Nair Praveen P.
Published: March 2017

Background: The objective was to compare operative factors, postoperative and surgical complications of open thyroidectomy by using FOCUS harmonic scalpel (HS) versus conventional hemostasis.Methods: A prospective randomised study in which 34 patients with benign/malignant thyroid disease patients underwent open thyroidectomy, patients were randomised into two groups, Group -1(HS) - included 19 patients which FOCUS Harmonic scalpel was used exclusively, Group -2(CH) included 15 patients in which conventional hemostasis was used exclusively. We recorded operative time, postoperative blood loss and drain output, postoperative complications and duration of hospital stay, patients were watched for 48-72 hours following surgery. The results were analysed by using student’s t-test.Results: Mean operative time for hemithyroidectomy was 53.40±9.07 minutes in HS group versus 85.25±17.03 minutes in CH group (p-value -0.004) mean operative in patients who underwent near total thyroidectomy is 67.21±10.36 in HS group v/s 109.60±29.35ml in CH group (p-value 0.001), postoperative drain output in patients who underwent hemithyroidectomy in HS group is 16.00±15.16 v/s 36.25±4.78 ml in CH group (p-value 0.008), postoperative drain output in patients who underwent near total thyroidectomy in HS group is 28.21±16.36ml v/s 45.50±8.95ml in CH group(p-value 0.006),length of hospital stay is 3.28±1.06 days in HS group v/s 4.20±1.39days in CH group,(p-value-0.083), complications like temporary hypocalcemia was present in 1 patient in HS group v/s 3 patients in CH group ,temporary RLN palsy was present in 2 patients in each group, there were no cases of permanent RLN palsy in either group, neither were the cases of permanent hypoparathyroidism in either group.Conclusions: FOCUS Harmonic scalpel will reduce operative time, reduces the incidence of symptomatic hypocalcemia but not temporary hypocalcemia,reduces postoperative drain output, reduces the duration of hospital stay, and shows no significance on incidence of temporary/permanent RLN palsy. FOCUS harmonic scalpel supposed to be more reliable and safe instrument that can be used instead of conventional hemostasis techniques in open thyroidectomy.
Occurrence of second primary cancer after curative resection of cholangiocarcinoma: a report of 5 cases
Authors: Long Hao , Wang Menghao , Gong Jianping , Hu Lan
Published: March 2017

The second primary cancer, a new cancer subsequent to the initial cancer, usually occurs in a person who has a history of cancer or the patient treated with curative resection. Although the pathogenesis of second primary cancer is unclear, it is always found that occurrence of second primary cancer is related to the age and family history. In our 5 cases’ reports, second primary cancer occurs after curative resection of cholangiocarcinoma. And most of the second primary cancers belong to well differentiated adenocarcinomas which grow slowly and never metastasize distally in early stage. Therefore, operative excision is the most effective treatment. At the same time, conventional examination after operation could improve early diagnosis and timely surgical treatment.
Endovascular management of bleeding peristomal varices
Authors: Rathod Krantikumar , Deshmukh H. L. , Popat Bhavesh , Alam Shamsh Tabrez
Published: March 2017

Bleeding from the peristomal varices is a rare recognised complication of stoma creation following proctocolectomy in a case of inflammatory bowel disease and associated sclerosing cholangitis. Peri-stomal varices are uncommon site of porto-systemic collateral formation in cases of pre-exiting portal hypertension and eventually a potential site of variceal bleeding. The management of peristomal variceal bleeding includes local compression, ligation, sclerotherapy and percutaneous variceal embolization; however these procedures are associated with high rate of recurrence because of the persistent raised portal venous pressure. Transjugular intrahepatic portosystemic shunt (TIPSS) is an artificial shunt created to reduce the raised portal venous pressure and can be used for the immediate relief of bleeding from peristomal varices. We are reporting a case of peristomal varices managed by transjugular intrahepatic porto-systemic shunt creation followed by coil embolization of peristomal varices and subsequently review the literature related to its management.
Anomalous origin of posterior tibial artery from anterior tibial artery: beware!
Authors: Hegde Abheesh Varma , Sunny Ann , Joshi Sunil
Published: March 2017

A 64 year old diabetic, hypertensive male with claudication and rest pain in his left leg was found to have diffuse narrowing below the politeal artery in the left lower limb with good collaterals. There was bifurcation of the right popliteal artery above the knee joint and an anomalous origin of the right posterior tibial artery from the anterior tibial artery. Awareness of anotomical variations is important for evaluation of the lower extremity arteriograms, for vascular surgeons during reconstructions such as femorodistal bypass graft procedures and embolectomy, during surgical techniques such as arthroscopy, tibial osteotomy, vascular reconstruction grafts, plastic surgical flaps and catheterization procedures.
Plexiform neurofibroma with AV malformation: amputation as treatment
Authors: Jain Vikas , Prakash Ved
Published: March 2017

Neurofibromatosis with arteriovenous malformation is not very common and can results in complications, making it treatment more challenging and futile. Young man with complicated neurofibromatosis with limb deformity and joint destruction by arteriovenous malformation with life threatening syncopal attacks and generalized weakness is a rare presentation in our case. Multiple surgeries with recurrent symptoms and destructed limb makes the conservative surgery futile, hence amputation is considered best in such circumstances by authors. Amputation can be considered in symptomatic patient with gross limb deformity in such case for better quality of life.
Oesophageal pseudotumor: a case report
Authors: M. P. Sreejayan , S. Arun
Published: March 2017

Inflammatory pseudo tumor (IPT) also known as inflammatory myofibroblastic tumor (IMT) is a tumor like mass of inflammatory origin. It is a pseudo sarcomatous lesion that has been reported most commonly in liver, followed by lung, mesentery and omentum but very rarely seen in esophagus. Proliferation of myofibroblastic cells is more in IMT. In IPT it is more of an inflammatory reactive or regenerative entity and has an overlapping with immunoglobulin G4-related disease. Lesion often mimics malignancy. A 20 year old male patient with history of dysphagia, more for liquids, underwent CT thorax, showing dilated oesophagus, with a moderately contrast enhancing eccentric soft tissue density lesion involving mid and lower esophagus extending for a length of 6cm. Patient underwent right thoracotomy, and a 5x3x3cm hard lesion involving lower esophagus was excised. Histopathology pointed towards inflammatory myofibroblastic tumor or inflammatory pseudotumor. Proliferation of myofibroblastic cells is more in IMT. In IPT it is more of an inflammatory reactive or regenerative entity and has an overlapping with immunoglobulin G4-related disease. Lesion often mimics malignancy.
Bilateral superior lumbar hernias: a case report and review of literature
Authors: Radhakrishna Veerabhadra , Tanga Sharad M.
Published: March 2017

Primary lumbar hernias are uncommon. They present with backache, flank pain, occasional nausea, feeling of weight or dragging sensation in the lumbar region. When they are small, they may be unnoticed leading to significant morbidity with the patient seeking referrals and therapy with no resolution of symptoms. They should be repaired in time to avoid dreaded complications of obstruction and strangulation. A sixty-year man presented with swelling and pain in the left loin. On evaluation, he was found to have bilateral superior lumbar hernias, which was treated with mesh repair.
A case report of axillary lipoblastoma
Authors: Deshpande Aditi , Kothari Paras , Gupta Abhaya , Dikshit Vishesh , Patil Prashant , Kulkarni Apoorva
Published: March 2017

We present a 14-month-old male with a large left axillary lipoblastoma and its management. Treatment of choice was complete excision. Incomplete excision leads to recurrence. Follow-up of at least five years was suggested.
Littré’s hernia: a rare complication of Meckel’s diverticulum
Authors: Sahoo Prakash Kumar , Rout Suman Saurav
Published: March 2017

Littré’s hernia is caused by the protrusion of Meckel’s diverticulum through an orifice in the abdominal wall. Meckel’s diverticulum is the most common congenital anomaly of the gastrointestinal tract that is generally asymptomatic and only manifests in a specific way when complications exist. An unusual complication of Meckel’s diverticulum is known as Littre’s hernia. It comprises less than 1% of all Meckel’s diverticulum. Usual sites of Littre hernia are right inguinal (50% of cases), umbilical hernia (20%), and femoral hernia (20%). We present a case of Littré’s hernia where we found a strangulated Meckel’s diverticulum in an inguinal hernia sac.
Gall stone ileus- a rare cause of intestinal obstruction: a case report and review of literature
Authors: Perumal Senthilkumar
Published: March 2017

Gall stone ileus is an uncommon and potentially serious complication of cholelithiasis. The formation of fistula between the gallbladder and duodenum may allow the gallstone to enter the intestinal tract. It carries a significant morbidity and mortality due to the advanced age of patients and high incidence of concomitant diseases. Here we report a case of a 75-year-old male patient who is a known diabetic, hypertensive and COPD with a recent history of surgery for obstructed umbilical hernia. He presented in the emergency department with small bowel obstruction owing to a large stone in ileum. The clinical presentation, radiological features, operative procedure and literature review are presented.
Fetus in fetu presenting as suprarenal mass: a case report
Authors: Azam Md Nawad , Mishra Baikuntha Narayan , Majhi Subrat Kumar , Joshi Ranjit Kumar , Pahi Prabin Prakash
Published: March 2017

Fetus in fetu (FIF) is a rare condition in which baby harbors its monozygotic malformed twin fetus inside its own body. This is even rarer in supra renal location, mostly asymptomatic but may present as a palpable abdominal lump. Here in we describe one newborn male child with antenatal diagnosis of mass abdomen. Post-natal ultra-sonogram of abdomen was suggestive of left supra renal mass. Operative findings and histopathology were consistent with fetus in fetu.
Chronic right lumbar suppuration following stone forgotten during laparoscopic cholecystectomy
Authors: Elghali Mohamed Amine , Massoudi Ikram , Ghrissi Rafik , Dhibet Tarek , Hamila Fehmi
Published: March 2017

The breaking of the gallbladder during laparoscopic cholecystectomy east of a common event, and usually harmless, even if stone are missed. Exceptionally these calculations are causing persistent suppuration and may pose therapeutic problems. We report the case of a woman who presented a chronic suppurative the right lumbar pit months after laparoscopic cholecystectomy. This illustrates the observations difficult diagnosis of this rare complication and providing imaging. as in our case, surgical removal of the calculi is the only way to ensure healing.
Cervical lymphadenopathy: a clinicopathological study
Authors: Motiwala Mohammed Ali , Dalmia Deepak , Behara Sanjaya Kumar
Published: March 2017

Cervical lymphadenopathy is one of the commonest presentations of underlying pathology of the head and neck region which has large number of differential diagnosis like neoplasms, infections (specific and non-specific), immune deficiency disorders and rare disorders like Inflammation. Pseudotumour (plasma cell granuloma) and Kikuchi-Fujimoto disease.

Methods: The present study is a prospective study conducted in our institution Dr B.A.M. Central Railway Hospital, Mumbai. Our study included 115 patients with cervical lymphadenopathy presenting with swelling of more than 1.5 cm size in longest diameter. All the patients included in our study are more than 12 years of age, in whom the lymph node did not regress after adequate antibiotic therapy in acute cases (i.e. Conservative management for at least 2 week), and all the chronic cervical lymphadenopathy patients.  

Results: Tuberculosis was found to be the most common cause of cervical Lymphadenopathy in 54.78% cases followed by reactive lymphadenitis in 22.61% cases, chronic nonspecific lymphadenitis in 12.17% cases and metastatic lymphadenopathy in 7.83% cases. Other causes were unknown primary in 1.74% cases and non-Hodgkin’s lymphoma in 0.87% cases. Sensitivity and specificity of FNAC was 79.36% and 100% respectively.

Conclusions: Tuberculosis, reactive lymphadenitis and malignancy are the most important cause of cervical Lymphadenopathy. They present in different age groups with different clinical feature. Fine Needle Aspiration Cytology (FNAC) is extremely sensitive and highly specific investigation for early diagnosis
Accuracy of FNAC in diagnosing thyroid swelling: a retrospective study
Authors: Shetty Hamsa , S. Sridhar , K. S. Gangadhar
Published: March 2017

Background: Aim of the study was to determine the accuracy of FNAC in diagnosing thyroid swellings.

Methods: A Retrospective study was conducted over a period of one year (September 2014 to September 2015), which included 54 patients, who presented with thyroid swelling to the ENT outpatient department.All the above patients were subjected to FNAC,and were operated for the swelling, their histopathological report were correlated with the pre-operative FNAC report to determine the accuracy of FNAC in correctly diagnosing the thyroid swelling. The data in this study was analysed using statistics analysis system (SAS) software.  

Results: Majority of the patients was in 3rd decade and females were more than males. The accuracy of FNAC in diagnosing thyroid swelling in the present study was found to be 77.78%.

Conclusions: FNAC is a safe, quick and inexpensive technique in diagnosing thyroid swelling with high degree of accuracy.
Comparative study between microscopic and endoscopic stapes surgery
Authors: Harikumar B. , Arun Kumar K. J.
Published: March 2017

Background: To investigate whether endoscopic stapes surgery is safer and less invasive than conventional stapes surgery using an operating microscope.

Methods: The subjects were 60 patients who were divided consecutively into group A undergoing microscopic stapedotomy and group B undergoing endoscopic stapedotomy. The procedures for endoscopic surgery were fundamentally the same as those for microscopic surgery, except for post aural incision used in some patients in microscopic group. The two surgical techniques were compared with respect to the operating time, approach, drilling of posterosuperior canal, manipulation of chorda tympani, visualisation of anterior crus, postoperative hearing, postoperative pain, and complications.  

Results: There were no differences of operating time or postoperative hearing between the endoscopic and microscopic groups. There was very little postoperative pain in the endoscopic group. Drilling at the posterosuperior part of the external auditory canal was less extensive in the endoscopic group than in the microscopic group. Visualisation of anterior crus of stapes was good in endoscopic group.

Conclusions: Endoscopic stapes surgeries are technically feasible, safe and promising. The main advantages were: easy access, virtually no trauma to the chorda tympani nerve and excellent vision. The disadvantages were the lack of stereoscopic vision, having to work with one hand only and the learning curve. 
Obstructive sleep apnoea in children –a neglected entity
Authors: K. Biniyam , Thotambailu Amulya M. , Kamath Shrinath
Published: March 2017

Background: Obstructive sleep apnoea syndrome (OSAS) is a spectrum which includes primary snoring, upper airway resistance syndrome, obstructive hypoventilation and obstructive sleep apnoea. Sleep disordered breathing  (SDB) is characterized by snoring, witnessed apnoea, frequent arousal, mouth breathing, restless sleep, irritability, recurrent upper respiratory tract infections etc.

Methods: This was a prospective observational study which included 20 children who presented to the otorhinolaryngology, pulmonary medicine, paediatric, oral and maxillofacial department were included in the study with clinical symptoms of obstructive sleep apnoea.  

Results: 20 children, 13 (65%) males and 7 (35%) females were included. Snoring was the most common complaint.15 (75%) were obese, 5 had adenotonsillar hypertrophy(25%) as the risk factor for OSA. 15 out of the 20 children were graded under mallampati class 1(75%), 4  class 2(20%), 1under class 3(5%). There was no significant association in severity of OSA between 2 genders (p=0.82). Positive correlation (r=0.52) was found between AHI and BMI and is found to be statistically significant (p=0.02), which suggests that degree of obesity does predict the severity of OSA.

Conclusions: Obesity is the most significant risk factor among them followed by adenotonsillar hypertrophy. Hence children who snore should undergo polysomnography and necessary corrective measures should be prescribed.
Technetium scintigraphy as a predictive tool of thyroid malignancy
Authors: Mohanty Sanjeev , . Sreenivas , T. Vinay Raj , . Devipriya , M. Vinoth
Published: March 2017

Background: Thyromegaly is a common cause of physician consultation. Solitary thyroid nodules are conventionally viewed with suspicion. Clinical examination cannot reliably distinguish between a solitary thyroid nodule and a dominant nodule in multinodular goiter. Ultrasonographical examination has its own pitfalls. Technetium 99 is a commonly used modality for the functional assessment of solitary thyroid nodule detection. It has the advantage of low cost with lower radiation dose to the exposed patients. On literature search, studies on technetium 99 scintigraphy for thyroid in context to the Indian scenario do not yield much information and very few studies are notable. This study was conducted to correlate and qualify thyroid cold nodule as detected by Technetium 99 pertechnetate thyroid scan. This study was conducted to correlate, qualify and compare the predictive value of Technetium 99 pertechnetate scintigraphy on solitary thyroid nodule via fine needle aspiration cytology and to countercheck with histopathological examination.

Methods: A prospective cohort study in a NABH, NAAC and JCI accredited tertiary care teaching university hospital was conducted over a period of 36 months. All the subjects underwent clinical assessment of the neck included standard examination techniques to segregate solitary thyroid nodules. They were then subjected to Technetium 99 pertechnate scintigraphy using the standard protocol. All the patients with solitary cold nodule underwent FNAC followed by nodule excision or hemi-thyroidectomy under general anaesthesia. All the specimens underwent histo-pathological examination by an experienced histopathologist. The results were statistically analysed using pearson chi-square test.  

Results: Cold nodules as detected by Technetium 99 pertechnetate thyroid scan is a reasonable indicator of probable malignancy via fine needle aspiration cytology. Occurrence of cold nodules is highest in 3rd to 5th decade of life (21-50 year age group). Occurrence of cold nodules is higher in females (83%) whereas occurrence of malignancy in cold nodules is higher in males (85%). Occurrence of malignancy in cold nodules is higher in subjects less than 21 and above 50 years.

Conclusions: Technetium 99m pertechnetate thyroid scintigraphy is an important preoperative tool in management of thyroid nodules and its routine use in all such patients is recommended especially to rule out cold nodules.
A computed tomography and endoscopy assisted study of the anatomical variations of lateral wall of nose in patients of chronic rhinosinusitis- our experience at a tertiary care centre
Authors: Suligavi Shashidhar S. , Fathima Afshan , Patil Mallikarjun N. , Doddamani S. S.
Published: March 2017

Background: Chronic rhinosinusitis (CRS) is a common and persistent illness that ENT surgeons encounter in their day to day practice. The lateral wall of the nose contains the ostiomeatal unit which is the key area targeted in the management of CRS. The lateral wall of nose shows several variations which can alter the course of the disease. It is of utmost importance for the ENT surgeon to be aware of these variations as they decide the overall line of management. The objectives of the study was to study the anatomical variations of the lateral wall of nose using computed tomography (CT) scans and nasal endoscopy in patients of chronic rhinosinusitis.

Methods: A one year study from April 2015 to March 2016 involving 50 patients attending the ENT outpatient department clinically diagnosed as CRS using the criteria of task force on rhinosinusitis were included in the present study. Patients underwent a CT scan and DNE and the anatomical variations of the lateral wall of nose were studied.  

Results: Concha bullosa was the most common anatomic variation noted in 20 (40%) of the total 50 patients. The other anatomic variations noted were uncinate process variations in 15(30%) patients, agger nasi cells in 3 (6%) patients, hypoplastic middle turbinate in 1 (2%) patient, paradoxical middle turbinate in 2(4%) patients, bulla ethmoidalis in 4 (8%) patients and Haller cells in 1 (2%) patient.

Conclusions: The lateral wall of nose is made up of several structures showing variations which can lead to the development CRS and affect the overall management. They should be evaluated pre-operatively in order to avoid intraoperative complications. CT scan and DNE both complement each other and effectively evaluate the anatomical variations of the lateral wall of nose.
A comparative study between nasal clips and anterior nasal packing in septoplasty/submucosal resection patients at VIMS Bellary, Karnataka
Authors: Kurle Geeta , Patil V. Shruthi , N. Manjunath
Published: March 2017

Background: Nasal packing is used primarily to control bleeding, for internal stabilization and to prevent postoperative complications in endonasal surgeries. Nasal septal clip is one of the alternatives, whose effectiveness in surgical practice is less studied upon. To compare the effectiveness between nasal septal clip and anterior nasal packing following septoplasty/submucous resection.

Methods: Prospective Randomised Controlled Study was conducted in Department of Otolaryngology at Vijayanagara Institution of Medical Sciences, Bellary, between November 2014 to May 2016. Study involved 100 patients fulfilling inclusion and exclusion criteria. Adopting sealed envelope technique, patients were allotted into two equal groups for anterior nasal pack and nasal septal clip following septoplasty or submucosal resection. Interventions were done following standard procedures and data was collected by using pre-tested proforma.  

Results: Mean age of anterior nasal pack group and nasal septal clip group was 27.86 and 25.24 years respectively. Intra-operatively, packing with nasal septal clip was easier with significantly less trauma to mucous membrane (X2= 6.353, P= 0.011), consuming significantly less time (t= 9.329, P<0.0001) and support provided to septum could be assessed visually when compared to anterior nasal packing. During immediate post-operative period and while pack removal, nasal septal clip had significantly less complications (P < 0.001). Follow-up complications like septal haematoma, synaechiae & septal perforations were lesser in nasal septal clip group

Conclusions: During intra-operative period, immediate post-operative period, during nasal pack removal and during follow-up period nasal septal clip provided technical superiority, smooth post-operative experience and lesser complications compared to anterior nasal packing proving nasal septal clip to be a better choice for nasal packing. Limitations of NSC are its availability and cost. 
Postoperative sore throat in patients undergone head and neck surgeries under endotracheal intubation and laryngeal mask anaesthesia
Authors: Rameshkumar Edakkattil , Ajayakumar Prathibha
Published: March 2017

Background: Postoperative sore throat (POST) is a frequent complaint among the subjects undergoing head and neck surgeries. Orotracheal intubation with the endotracheal tube (ETT) and laryngeal mask (LM) was used for anaesthesia.  This study was aimed to analyze the effect of variation in cuff pressure and size of ETT and LM mask anaesthesia on post-surgical pain.

Methods: Patients (ages of 10-79) who underwent head and neck surgeries by ETT intubation and LM anaesthesia were included in the study. The pain was measured as pain score during different cuff pressure and size of tube or mask and data was statistically analyzed.  

Results: Total 100 subjects of each group and both genders were included in the prospective study. No statistically significant difference could be observed among the number of cases in both groups. Among the patients, females were dominant (p = 0.405). The intensity of pain was gradually decreased during the 2nd and 3rd post surgical days in both groups. The frequency of patients with pain in the LMA group was less than that of ETT group on the 1st day. No correlation between the pain score and cuff pressure or size of ETT and LMA could be evidenced.

Conclusions: The postoperative sore throat can be effectively reduced by LMA. The pain score and frequency of patients with pain in the LMA group was less than that of ETT group. No correlation of pain score with different cuff pressure and size of tube or mask could be evidenced. 
Prospective study on sterilization of rigid endoscopes in various otolaryngology clinics
Authors: Lakshmanan Varun , M. K. Goutham , Karnaker Vimal , Aroor Rajeshwari , Kamath P. Shrinath , Bhat Vadish , Varghese Irene Gee
Published: March 2017

Background: Rigid endoscopes have revolutionized the diagnosis and management of upper aerodigestive pathologies. Inadequate disinfection and sterilization techniques carry increased risk for cross infection. Hence, they require high level disinfection to effectively reduce the bacterial and fungal contamination of rigid endoscopes. The present study analyses the various techniques of sterilization practised in Mangaluru, Karnataka, at different Otorhinolaryngology clinics.

Methods: This prospective descriptive study was done on 30 rigid endoscopes. Swabs were taken from the endoscopes and container, and send for detailed microbiological examination. The different methods practised at various centres were documented.  

Results: The various sterilization technique practised was predominantly cetrimide and chlorhexidine solution (savlon) wash, ETO and Formaldehyde. However, among all techniques the microbiological studies revealed no growth.

Conclusions: Rigid endoscopes have emerged as the best diagnostic equipment for otorhinolaryngologists. With regard to high level disinfection and sterilization, the endoscope must undergo recommended techniques. In our study the most commonly used techniques was cetrimide and chlorhexidine solution wash and less commonly ETO and Formaldehyde. The use of standard sterilization technique and maintaining the rigid endoscopes in sterile storage container is the key to maintain an organism free environment. The standard technique of prewash with water and soap water, then washing with cetrimide and chlorhexidine solution, then store the endoscope in sterile container is our recommendation. 
A clinical study of the patients with elongated styloid process
Authors: Choudhari Suhas Y. , Sangavi Aravind B.
Published: March 2017

Background: The elongation of styloid process is considered an anomaly which can cause throat pain and cervico-facial pain and trigger a series of symptoms such as dysphagia, odynophagia, facial pain, ear pain, headache, tinnitus and trismus. The present study was undertaken find out the length of styloid process in patients with throat pain.

Methods: A prospective study was conducted among 150 patients. A detailed ENT and general examination was done apart from palpation of the styloid along the posterior tonsillar pillar, a routine Hematological tests with estimation of serum calcium levels, and X-ray towne view was done.  

Results: The female to male ratio was found to be 1.6:1. Of the 150 cases 92 were middle aged females, the severity of symptoms were directly proportional to the length and the thickness of the styloid. The symptoms ranged from foreign body sensation in the throat to cervicofacial pain and otalgia. Serum Calcium levels were elevated in 60% of the cases.

Conclusions: Elongation of the styloid being multi-factorial in origin. A strong suspicion is required on the part of the surgeon to rule out this particular entity. A simple palpitation and an x- ray Towne view can establish the diagnosis of elongated styloid process.
Clinicoetiological pattern and pharmacotherapy practices in patients with new onset vertigo: findings from a prospective multicenter registry in India
Authors: Kameswaran Mohan , Pujari Shripad , Singh Jasveer , Basumatary Lakshya Jyoti , Sarda Kushal , Pore Rakesh
Published: March 2017

Background: The objective was to evaluate the clinicoetiological pattern and pharmacotherapy practices of new onset vertigo in India.

Methods: This multicentre, prospective, registry was conducted in adult patients across 37 centres. Enrolled patients were followed at week 1, month 1 and 3 to assess clinicoetiological characteristics, prescribed pharmacotherapy, safety and effectiveness of treatment.  

Results: Of the 1520 patients enrolled, 1428 (93.95%) completed the study. The mean (SD) age was 50.2 (±15.37) years and 53.2% were women. Of 202 patients reporting co-morbidities, 55.4% had cardiovascular disease and 38.6% had diabetes mellitus. Peripheral causes were predominant in majority (74.3%); benign paroxysmal positional vertigo (BPPV) being the most frequent (67.58%). Migraine affected 68.9% (80/116) patients, .as the central cause. Betahistine (74.6%) and prochlorperazine (21.75%) were the top two drugs of choice irrespective of origin, preferred by all treating specialists. Both the drugs significantly prevented recurrence by week 1 (prochlorperazine: 76.6%; betahistine: 64.2%) (p<0.001) and over 3 months. A lower daily dose of betahistine (15.6±5.26 mg) was preferred. Almost half complained of nausea and vomiting; prochlorperazine significantly reduced recurrence of both within a week (p<0.001). The treatments were well-tolerated with no reported adverse drug reactions.

Conclusions: The study demonstrates vestibular vertigo, BPPV to be the dominant type in Indian patients with new onset vertigo. Betahistine and prochlorperazine top the physicians’ preference list, with equal benefits in preventing recurrence. Prochlorperazine has an additional antinausea and antiemetic property, thereby may improve patient satisfaction. Prescription of a lower dose of betahistine calls for the need to sensitize physicians.
Extradimension of fasciocutaneous flap in the surgical management of postaural fistula, a complication of chronic otitis media – squamous type
Authors: Vathulya Madhubari , Malhotra Manu , Varshney Saurabh
Published: March 2017

Post aural fistula is one of the complications of squamous variety of chronic otitis media (COM-S). For decades together a lot of new surgical techniques have been introduced in the treatment of COM-S out of which canal wall down mastoidectomy is most commonly practised. Despite these efforts many patients presenting with COM-S end up in tertiary referral centers at a late stage with complications like fistulas and by this time a number of procedures have already been done on them. A 19 year old female presents with Postaural fistula as a complication of COM- S type. Due to the local scarring, newer flap options needed to be sought to obliterate the mastoid cavity. This article demonstrates the extra dimension for the usage of fasciocutaneous flap from neck region to treat patients of recurrent postaural fistula.
Juvenile buccal pleomorphic adenoma: a rare case report
Authors: AlShehri Ali Abdullah , Al-Qarni Saad Nasser , Hudise Jibril Yahia , Sumaily Ibrahim Ali
Published: March 2017

Salivary glands tumors are relatively uncommon in pediatric age group. Less incidence is expected in minor salivary glands of pediatric patients. In the buccal minor salivary glands only five cases reported as pleomorphic adenoma in english literature. Herein we present an 11 years old boy presented with right side buccal mass which is mobile on physical examination with normal overlying buccal mucosa. Histopathology revealed a pleomorphic adenoma. Such case is rare in this part of oral cavity especially in young age group. our case is the third youngest patients with buccal pleomorphic adenoma. Reporting it will add a material to the literature for further studies on such disease presentation.
An 80 year old lingual haemangioma: a case report
Authors: Agius Marija , Chircop Daniel M. , Cutajar John C. , Said Mario E.
Published: March 2017

Haemangiomas are benign vascular tumours which are commonly encountered in head and neck regions. They are subdivided in cavernous haemaniogma and vascular malformations. Lingual haemangiomas pose a potential airway risk because of their position. This case report is about the management of a patient with a lingual haemangioma which was asymptomatic for 80 years but which was eventually removed in view of recurrent angio-oedema.
Retropharyngeal abscess rare presentation in a 11 months old infant: a case report
Authors: Halawani Roa T. , Aboshargyah Bayan
Published: March 2017

Retropharyngeal abscess (RPA) is a rare deep neck infection that usually affects young children. It is the most common deep neck infection in children. We would like to present this case because of unusual presentation at this age.
Bilateral facial nerve palsy: challenges in diagnosis
Authors: Yadav Mayank , Farooqui M. Khalid , Naik S. M. , Naz Ruby
Published: March 2017

Bilateral facial palsy is a rare condition accounting for less than 2% of all cases of facial nerve palsy. Most of the patients develop bilateral facial nerve palsy secondary to underlying medical condition, which can be neurologic, infectious, traumatic, neoplastic or metabolic disorder. Clinicians should be careful enough to face the diagnostic dilemma and to rule out wide range of differential diagnosis in these cases, some of which can be potentially fatal. Treatment should be initiated according to the diagnosis. We are reporting a case of 26 year old man who presented to our ENT OPD with bilateral facial nerve palsy. The condition could not be attributed to any particular aetiology hence presented a diagnostic dilemma. We endorse the practice of considering wide range of differential diagnosis in all case of bilateral facial nerve palsy. These patients should undergo prompt laboratory and radiological investigations and gruelling evaluation of underlying cause for further specific management.
Sinonasal teratocarcinosarcoma: is minimally invasive resection followed by adjuvant histology directed chemo-radiation a better alternative to radical excision? Case report
Authors: Singh N. Dhaneshwar , Sen Kanwar , Sharma Arun , Bharadwaj Meenakshi
Published: March 2017

Sinonasal teratocarcinosarcoma (SNTCS) is a rare higly malignant tumour occuring almost exclusively in the sinonasal tract. This aggressive tumour arising from the primitive embryonic or immature pluripotential cells of olfactory epithelium has high propencity for loco-regional recurrence and mortality. SNTCS generally presents with relatively benign symptoms like nasal obstruction and recurrent epistaxis in its early stage. In advance stage with orbital and intracranial spread other symptoms raising suspicion of malignancy, such as dysphagia, odynophagia, epiphora, vision loss, exophthalmos, anosmia, headache and altered sensorium appears. In view of its aggressive behaviour, radical excision with or without chemoradiation is advocated as the optimum treatment. Local recurrence of SNTCS after excision has been reported as high as 45% with a mean recurrence time of 21.3 months. Even though distant metastasis is rare, local recurrence frequently leads to treatment failure and subsequent death. Here we share our experience of SNTCS in a 23 year old male managed with endoscopic craniofacial resection followed by histocytology directed chemotherapy with external beam radiation. He remains disease free in last 3 years of follow up.

 
Bilateral Hurthle cell adenoma of thyroid: a rare case report
Authors: Singh Rahul Kumar , Goyal Amit , Elhence Poonam , Kumar Amit
Published: March 2017

Hurthle cell of adenoma of thyroid gland is rare neoplasms of the thyroid.  Size more than 4 cm is rare finding and moreover the occurrence of a multifocal Hurthle cell adenoma is not supported by antecedents in literature. Sonography fails to identify its potentials for malignancy while fine needle aspiration cytology couldn’t differentiate it from Hurthle cell carcinoma of thyroid. The management of Hurthle cell adenoma and Hurthle cell carcinoma is quite different and hence diagnostic dilemma should be sorted out early. A 26 year old female presented with bilateral thyroid swelling. Ultrasonography of thyroid gland showed complex solid cystic nodules in bilateral thyroid lobes with right thyroid lobe measuring 4.1×3.4×2.5 cm and left thyroid lobe measure 3.1×1.7×1.6 cm. Fine needle aspiration cytology (FNAC) was suggestive of papillary malignancy with extensive Hurthle cell changes (Class V, Bethesda classification). The patient underwent total thyroidectomy with bilateral parathyroid gland preservation. Histopathology revealed it as Hurthle cell adenoma (HCA) involving bilateral lobe and multifocal in nature. The treatment of choice for Hurthle cell carcinoma is total thyroidectomy with neck dissection depending on the nature of the lesions. However the treatment of Hurthle cell adenoma is only hemithyroidectomy or lobectomy as it is a benign condition. Differentiation of these two entirely different conditions warrants more studies.