bluuebunny/crossref_metadata_2025 huggingface dataset:
Facial Palsy and Mastoiditis from Fibrous Dysplasia
Authors: Bickle Ian C.
Published: April 2019

This young adult man presented to ENT clinic with a complaint of left facial weakness and persistent left retro-auricular pain. High resolution CT of the mastoids was performed following clinical assessment.

In this case, there is extensive sclerotic bony expansion with a ground-glass appearance involving the left zygoma, sphenoid and petrous temporal bone.

The bony expansion is centred on the medullary bone and has an abrupt zonal transition (Figure 1).  The bone involvement encompasses almost complete bony stenosis of the left external auditory meatus down to 1-2mm with consequential fluid in the external auditory canal and middle ears (Figure 2). The bony expansion involves both the tympanic and mastoid segments of the facial canal which are stenosed.  The ossicular chain remains intact.  The left mastoid air cells are under-pneumatised and completely occupied by fluid.

DISCUSSION

Fibrous dysplasia (FD) is a benign congenital process that typical manifests itself as a localized defect in osteoblastic differentiation and maturation. Normal bone is replaced with haphazard fibrous tissue and immature woven bone.1

Fibrous dysplasia is predominantly a condition of children and young adults (those less than 30 years of age).  Disease growth usually halts after the third decade of life. FD may be a monostotic or polyostotic in nature and in some cases is part of a syndrome, such as McCune-Albright.2

The zygomatic maxillary complex is the most commonly reported location for fibrous dysplasia.  The temporal bone is a typical site in polyostotic disease, in up to 70%, but less often observed in monoostotic disease.  Disease of the temporal bone most typically results in hearing impairment due to bony stenosis of the external auditory canal. Facial nerve involvement is a less frequent feature, resulting in facial nerve paralysis, due to involvement of the nerve as it exits through the petrous temporal bone.2 The anatomical location of the facial nerve compression is hard to access and treat surgically.3

CT is the imaging investigation of choice giving the most exquisite bony definition.  Typical CT features (as shown in this case) are:

A diffuse ground-glass appearance to the affected bone

Homogeneously sclerotic bone

Well-defined borders between the diseased and unaffected bone (abrupt zone of transition)

Bony expansion, with overlying cortical bone intact

The CT appearances apply equally to the anatomical site involved, however the combination of imaging appearances can be variable presenting a diagnostic dilemma, which may merit a confirmatory bone biopsy.
Metastasizing Ameloblastoma
Authors: Atun Jenny Maureen L. , Carnate Jose M.
Published: April 2019

A 27-year-old man presented with an 8 cm diameter left maxillary mass and an enlarged cervical lymph node at levels II to III. There was a reported history of a previous unspecified operation on the maxillary mass which had yielded a diagnosis of ameloblastoma. Total maxillectomy with modified radical neck dissection was subsequently performed.

Microscopic examination of the maxillary mass shows epithelial islands and cords in a fibro-collagenous stroma. (Figure 1) The islands and cords are lined in the periphery by palisaded columnar cells with regular ovoid nuclei exhibiting reverse polarization. The nuclei are uniform with dispersed chromatin and no significant atypia. Towards the center of these islands are loosely arranged spindly to stellate cells (“stellate reticulum”). (Figure 2) Microscopic examination of the largest submitted lymph node shows an epithelial neoplasm with identical histologic features as the maxillary mass and a residual rim of lymphoid tissue at the periphery enclosed by the nodal capsule. (Figure 3) Similarly, there is neither atypia nor pleomorphism and only a few typical mitotic figures are seen in the nodal tumor. (Figure 4) These features support the diagnosis of a metastasizing ameloblastoma (MA).

 

Metastasizing ameloblastoma is rare with only about 70 reported cases.1-5 Both the gnathic primary tumor and the metastatic foci have typical morphologies of a benign ameloblastoma with bland nuclei and absent to rare mitosis.6,7 There are no morphologic criteria that can predict this metastatic behavior. Thus, this diagnosis can only be made in retrospect upon the appearance of metastasis in a gnathic tumor that would otherwise have been diagnosed as a usual benign ameloblastoma.1-7 Suggested risk factors include rapid tumor growth, large primary tumor, delay in treatment, mandibular site, prior radiotherapy and chemotherapy.4,5 However, what is most consistent in the literature is the history of multiple recurrences and multiple surgical interventions.1,4,5

 

The differential diagnosis is an ameloblastic carcinoma (AC). Both MA and AC are considered as the malignant counterparts of ameloblastoma.7 However AC is characterized by the presence of the usual cytologic features of a malignant neoplasm, such as nuclear pleomorphism, hyperchromasia and brisk mitotic activilty – features that are lacking in MA.6,7

 

The literature on metastasizing ameloblastoma lists the lungs (70 to 88% of cases) and the cervical lymph nodes (15-37.8% of cases) as the most common sites of metastasis.1-5 Increased Ki-67 labeling and CD10 immunoreactivity have been reported to have significant correlation with recurrence.8,9 Whether these observations also apply to the risk of metastasis is not known due to the rarity of cases and hence the small subject populations of these studies.  

 

As the risk of metastasis cannot be predicted by morphology, long-term follow-up appears prudent in all cases of ameloblastoma, especially if characterized by recurrences and prior surgical interventions.
Prevalence of Nasopharyngeal Carcinoma among Patients with Nasopharyngeal Mass in a Philippine Tertiary Training Hospital
Authors: Lara Hasmin Hannah R. , Monroy Angelo A.
Published: April 2019

Objectives: To determine the prevalence and identify the types of Nasopharyngeal Carcinoma (NPCA) among patients with nasopharyngeal mass seen at a tertiary university training hospital in the Philippines from January 2006 – July 2012 and identify possible factors associated with nasopharyngeal carcinoma.

Methods:  A retrospective cross-sectional study was performed at a tertiary university training hospital among cases (n=179) seen with nasopharyngeal mass at the ENT outpatient department. Histopathology results and patient medical charts were collected and reviewed after IRB approval. The age at diagnosis, sex, place of residence, occupation and chief complaint was compared among patients with positive histopathology of NPCA only.

            Design:           Retrospective, cross sectional study

            Setting:           Tertiary Private University Training Hospital

Participants:  179 patients with nasopharyngeal mass

Results:  96 (54%) cases with nasopharyngeal mass seen at the ENT outpatient department were positive for nasopharyngeal malignancy. The remaining 83 (46%) cases with nasopharyngeal mass had a benign histopathology. NPCA was more common among males (58%) than females (42%). The most common form of NPCA was non-keratinizing undifferentiated NPCA (47%) followed by poorly differentiated squamous cell carcinoma in 18 (19%). The most common chief complaint was a neck mass, followed by decreased hearing.

Conclusion: There was a higher proportion of nasopharyngeal malignancy among male patients with nasopharyngeal mass, and the most common chief complaint was a neck mass. Future research should integrate data with other hospital institutions to obtain more accurate demographic data of the local prevalence of NPCA. A detailed record of the ethnicity, diet, occupation, smoking history and family history of cases should be obtained to correlate possible risk factors of NPCA among patients with nasopharyngeal mass in our setting.

 

 

Keywords: Nasopharyngeal carcinoma, nasopharyngeal mass, epidemiology, prevalence
Tumoral Calcinosis in Secondary Hyperparathyroidism
Authors: Bautista Reinzi Luz S. , Lopa Ramon Antonio B. , Cabungcal Arsenio Claro A. , Dela Cruz Anna Pamela C. , Lo Tom Edward N.
Published: April 2019

Objective: To report a case of tumoral calcinosis from secondary hyperparathyroidism and to describe its surgical management.

Methods:

Study Design: Case report

Setting:           Tertiary public university hospital

Patient:           One

Results: A 34-year old woman presented with progressively-enlarging bilateral upper extremity masses. Diagnostic tests revealed hyperfunctioning parathyroid glands. The patient underwent subtotal parathyroidectomy, right thyroid lobectomy with isthmusectomy, and transcervical thymectomy. Follow-up revealed marked decrease in parathyroid hormone, and progressive resolution of the tumoral calcinosis.

Conclusion: Subtotal parathyroidectomy and transcervical thymectomy have a role in the management of tumoral calcinosis, and in this case led to excellent post-operative results. The  rare presentation of secondary hyperparathyroidism and intervention in this patient may have potential lessons for future management of similar cases.

Keywords: tumoral calcinosis, parathyroid, parathyroidectomy, thymectomy
Naso-Glabello-Frontal Advancement Reconstruction for Chondroid Syringoma of the Nasal Tip
Authors: Tangco Ivy V. , Ayahao Felixberto D.
Published: April 2019

OBJECTIVE: To present a naso-glabello-frontal advancement modification of the dorsal advancement (Rintala) flap for reconstruction of an unusual case of chondroid syringoma occurring at the nasal tip.

METHODS:

            Design: Case report

            Setting: Tertiary Government Training hospital

            Patient: One

RESULTS: A 23-year-old man who presented with a nasal tip mass initially diagnosed as a benign adnexal tumor underwent excision and reconstruction with a naso-glabello-frontal advancement flap modification of the dorsal advancement flap with median brow lift. The procedure resulted in nasal tip reconstruction with minimal scars, including a horizontal upper medial brow margin scar that eventually became less apparent. Final histopathology revealed a rare benign mixed tumor, chondroid syringoma.

 

CONCLUSION: The naso-glabello-frontal advancement flap is a one-stage procedure that can be used to reconstruct such a cutaneous nasal defect after tumor excision.  The modification observes nasal aesthetic subunits and may have a better aesthetic outcome than traditional rotational flaps or advancement flaps.

 

Keywords: rhinoplasty, surgical flaps, sweat gland neoplasm
Olfactory Neuroblastoma
Authors: Bickle Ian C.
Published: April 2019

This 57 year-old woman presented with a seizure. She had a history of attending the ENT and neurosurgical departments for more than a decade. At the time of her initial presentation many years prior, her main complaint was of nasal congestion. A nasopharyngeal biopsy confirmed an olfactory neuroblastoma.

 

Olfactory neuroblastoma is an uncommon slow growing tumour of the nasal cavity with no established etiological basis. With a neuroectodermal origin, it arises from the olfactory epithelium of the upper nasal cavity.1 Most cases arise from the cribriform plate, upper third of the nasal septum, superior turbinates or anterior ethmoidal air cells.  However, it typically presents late when multiple structures are involved, which may include the orbits and intracranial compartments.2

 

Accounting for approximately 2% of sinonasal tumors, although often late to present, ironically only a minority of patients experience anosmia.3 The commonest complaint at initial presentation is nasal blockage accounting for nearly a quarter of cases, with headache and epistaxis the next most frequent symptoms.1

 

Multi-modality imaging is essential in that the most recognized management of this infrequent tumor is a combination of craniofacial surgery and radiotherapy. The imaging pathway in this case was typical, with CT and MRI complementing each other in maximizing tumor delineation. Computed Tomography has superior definition is reviewing bony involvement which is a typical finding, whereas MRI has superiority in evaluating the extent of soft tissue invasion and establishing tumor boundaries against post obstruction fluid in the paranasal sinuses.3 In this case the CT illustrates the gross destruction of the skull base, orbital and sinus margins. (Figure 1-4) The MRI outlines the extension of disease involving the pituitary fossa, brainstem and frontal sinus invasion. (Figures 5 and 6)
Pneumococcal Conjugate Vaccine (Non-Typeable Haemophilus influenzae (NTHi) Protein D, Diphtheria or Tetanus Toxoid Conjugates) in Prevention of Acute Otitis Media in Children: A Cohort Study
Authors: Chu Trixy G. , Cachola Daniel Rafael R. , Regal Mary Agnes S. , Llamas Agnes Cecille G. , Martinez Norberto V. , Santos Wilfredo R.
Published: April 2019

Objective: To compare the incidence of acute otitis media among children aged 2 to 6 months old in Sampaloc, Manila who were previously given 3 doses of pneumococcal conjugate vaccine (Non-Typeable Haemophilus influenzae (NTHi) protein D, diphtheria or tetanus toxoid conjugates) and those who did not receive the vaccine, over a period of one year.

Methods:

Study Design:             Cohort Study

Setting:                       Primary Health Center in Sampaloc, Manila, Philippines

Participants:              Medical records of well children aged 2 to 6 months were reviewed for inclusion. Participants were categorized into vaccinated and unvaccinated groups. Both groups underwent baseline history and physical examination including otoscopy and any signs and symptoms of active ear infection were noted.  Subjects were followed up for a period of 1 year on a monthly basis for signs or symptoms of acute otitis media.

Results: A total of 176 subjects participated in the study. The overall incidence of AOM among participants was 5.11% (9 out of 176). An AOM incidence of 3.75% (3 out of 80) and 6.25% (6 out of 96) was found among the exposed and unexposed groups, respectively. Fisher’s exact test (one-tailed) p value =.34, relative risk (RR) .6 (95 percent CI 0.155, 2.323).

Conclusion: The results of this study showed no difference in the development of AOM in the two groups. However, based on the relative risk, Pneumococcal conjugate vaccine is still beneficial in preventing AOM in children.

Keywords: Pneumococcal Conjugate Vaccine; Acute Otitis Media
Rhinofacial Conidiobolomycosis in a 16-Year-Old Girl
Authors: Parilla Xirxiz Vin C. , Cachuela Joseph E.
Published: April 2019

Objectives : To present the case of a 16-year old girl with progressive facial disfigurement spanning 11 months due to Conidiobolomycosis.

Methods:

            Design:           Case Report

            Setting:           Tertiary Government Hospital

            Patient:           One

Results: A 16-year-old girl presented with a severe facial deformity of 11 months duration. The lesion started as a swelling in the right nasal vestibule, which later involved the entire nose, forehead, cheeks, upper and lower lip. A series of tissue biopsies revealed varied results -- chronic inflammation, chronic granulomatous inflammation with foreign body type giant cells, and eosinophilic granuloma—resulting in delayed provision of appropriate treatment. On the fourth biopsy using Grocott methenamine silver staining technique, septate fungal hyphae were identified. With a diagnosis of rhinofacial conidiobolomycosis, she was started on Itraconazole 100mg three times daily for eight months. Her facial swelling subsided gradually during the course of treatment and no systemic drug-related complications were observed.

Conclusion: Rhinofacial conidiobolomycosis is a rare chronic localized fungal infection that usually affects midline facial structures in immunocompetent hosts. Early detection and diagnosis, and appropriate medication can give rapid resolution. To the best of our knowledge, this may be the first documented case of rhinofacial conidiobolomycosis in the Philippines.

 

Keywords: Conidiobolomycosis; Conidiobolus; fungal infection; Itraconazole, Therapeutic use
True Congenital Macroglossia Surgically Managed Using a Modified Kole Technique
Authors: Smith Jenifer C. , Vicente Gil M.
Published: April 2019

Objective: To describe a 2-year old boy with true congenital macroglossia surgically managed using a modified Kole technique. 

Methods:

Study Design:             Surgical Innovation

Setting:                        Tertiary Government Hospital

Patient:                        One

Results: A 2-year-old boy presented with congenital macroglossia, associated with difficulty feeding and phonating. On physical examination, the massive tongue had both increased length and width. At rest, it protruded between the upper and lower teeth, with drying and fissuring of the tip. Dribbling of saliva and mandible prognathism were also noted.  The child was surgically treated with a modified Kole technique, wherein the apex of the anterior wedge resection was extended to the posterior third midline. Final histopathology was consistent with cavernous hemangioma.

Conclusion:  The modified Kole technique proved viable, as the postoperative results were considered satisfactory. Tongue volume was uniformly reduced in length and width, enabling mouth and jaw closure, while tongue sensation and mobility were preserved. Feeding, speech intelligibility and cosmesis were markedly improved.  Future application of this modification may prove its usefulness.     

Keywords:  macroglossia; glossectomy; congenital macroglossia
Low-Grade Cribriform Cystadenocarcinoma of the Parotid Gland
Authors: Carnate Jose M.
Published: April 2019

This is the case of a 44-year-old woman with a one-year history of a left pre-auricular mass. The surgical specimen is a 5 centimeter diameter tan-brown irregularly-shaped tissue whose cut surfaces are brown with cystic spaces. Microscopic sections show cystic and dilated ductal spaces lined by cells forming irregular, variably-sized secondary spaces. These spaces are arranged in a cribriform pattern that is reminiscent of breast ductal hyperplasia. (Figure 1) The ductal cells lining the spaces are small, multilayered, and generally bland. The superficial cells show apocrine-type cytoplasmic snouting. There is no significant nuclear atypia or mitotic activity noted. Necrosis is also absent. (Figure 2) Based on these features, we signed the case as a low-grade cribriform cyastadenocarcinoma (LGCCC).

 

LGCCC is an uncommon tumor presenting primarily as cystic parotid masses in elderly females. The histologic hallmark of this tumor is its morphologic resemblance to the spectrum of breast lesions ranging from ductal hyperplasia to low-grade ductal carcinoma-in-situ.1-4

 

            Microscopic sections show an unencapsulated tumor consisting of single or multiple cysts lined by proliferated small and bland ductal cells with fine chromatin and small nucleoli. Within the cystic spaces, the cells are often arranged in a cribriform pattern with anastomosing intracystic micropapillae lining the cavity. Many superficial cells show apocrine-type secretions. Thus, the over-all appearance is quite comparable to breast lesions that are termed atypical ductal hyperplasia and low-grade ductal carcinoma-in-situ.1-4 Focal invasion into the surrounding tissue can be seen. Perineural or vascular invasion however is typically absent. Cellular pleomorphism and mitoses are also usually absent and necrosis is rare. Occasional tumors however may demonstrate a transition to an intermediate or high-grade cytology with the appearance of scattered mitoses and focal necrosis.1,2

 

            This tumor needs to be distinguished from a conventional cystadenocarcinoma. The latter is a more frankly invasive tumor with smaller duct-like structures that infiltrate into the salivary parenchyma and surrounding connective tissue. A papillary-cystic variant of acinic cell carcinoma will have areas of acinar differentiation and a greater degree of epithelial proliferation.1,5 A high-grade salivary duct carcinoma will have a high-grade cytology with more frequent necrosis, mitoses, and pleomorphism.6 Special stains that help in the differential diagnosis include Periodic Acid-Schiff (PAS) stain with Diastase digestion (diastase-resistant cytoplasmic granules in an acinic cell carcinoma), and S100 (strong diffuse positivity in LGCCC).1

 

            LGCCC is treated by complete surgical excision. Although there are only a few reported cases with follow-up, to our knowledge, none, to date, have recurred.1-4
Laryngeal Cancer Neck Node Metastases: Patterns of Spread
Authors: Austria Mark Jansen D.G. , Roldan Rodante A.
Published: April 2019

Objective: To determine the patterns of neck node metastases of patients with laryngeal carcinoma in our institution.

Methods:

            Design:           Chart Review

            Setting:           Tertiary Public Hospital

Subjects:        Records of thirty-eight (38) laryngeal cancer patients who underwent laryngectomy with neck dissection from January 2010 to January 2017 were considered.

Results: Records of 34 laryngeal cancer patients with ages ranging from 45-72 years old were included. The most common subsite was the glottis, with 19 (55.88%) patients. The distribution of neck node metastases for all subsites were 0/64 (0%) for level I, 22/64 (34.37%) for level II, 12/64 (18.75%) for level III, 7/64 (10.93%) for level IV, 0/64 (0%) for level V, and 1/64 (1.56%) for level VI. Distributions of lymph nodes per subsite for supraglottic SCCA were 0 (0%) for level I, 3/22 (13.63%) for level II, 2/12 (16.66%) for level III, 1/7 (14.28%) for level IV, 0 (0%) for level V, and 0/1 (0%) for level VI. For glottic SCCA, they were 0 (0%) for level I, 12/22 (54.54%) for level II, 8/12 (66.66%) for level III, 3/7 (42.85%) for level IV, 0 (0%) for level V, and 1/1 (100%) for level VI; and for transglottic SCCA, they were 0 (0%) for level I, 7/22 (31.81%) for level II, 5/12 (41.66%) for level III, 3/7 (42.85%) for level IV, 0 (0%) for level V, and 0/1 (0%) for level VI.

Conclusion: Our findings show that neck node levels II, III, and IV are most frequently affected in laryngeal carcinoma patients in our sample, and may guide recommendations for neck dissection in our institution.

Keywords: Laryngeal Cancer, Metastases, Neck dissection, Supraglottic, Subglottic, Glottic, Transglottic
Thyroid Gland Invasion in Laryngeal Carcinoma
Authors: Vitamog Maria Concepcion F. , Castañeda Samantha S.
Published: April 2019

Objective: To determine the prevalence of, and describe transglottic cancer with thyroid cartilage invasion as a possible risk for, thyroid gland invasion in a series of patients with laryngeal carcinoma who underwent total laryngectomy with thyroidectomy.

Methods

Study Design:            Retrospective case series

Setting:                       Tertiary government hospital

Subjects:                    61 laryngeal carcinoma patients who underwent total laryngectomy with hemi- or total thyroidectomy from January 2010 to August 2017.

Results

Out of 61 patients with laryngeal carcinoma, 11 patients had supraglottic, 11 glottic, 2 subglottic and 37 had transglottic involvement. Eleven had thyroid cartilage invasion, all of whom had transglottic tumors. Of these 11 patients, only 1 had thyroid gland invasion. This was a case of a 78 year-old male patient, with poorly differentiated SCC stage IVa transglottic tumor with thyroid cartilage invasion.

Conclusion

Thyroid gland invasion was uncommon in our sample of laryngeal carcinoma patients who underwent laryngectomy and thyroidectomy. Although transglottic involvement with thyroid cartilage invasion may increase the risk of thyroid gland invasion, it could not be confirmed by our series. Perhaps thyroidectomy should not be routinely performed on all patients with laryngeal carcinoma who undergo total laryngectomy, but more rigorous studies are needed to establish this.

 

Keywords: laryngeal carcinoma, transglottic, thyroid cartilage invasion, thyroid gland invasion, thyroidectomy
An Initial Overview of Management and Treatment Outcomes for Head and Neck Hemangiomas
Authors: Fernandez Rodolfo U.
Published: April 2019

Objective: To provide an initial overview of the outcomes of different treatment modalities used for hemangiomas.

Methods:

Design:           Case Series

Setting:           Tertiary National University Hospital

Participants: Records of 21 patients diagnosed with head and neck hemangiomas in the Philippine General Hospital Department of Otorhinolaryngology from 2009 to 2014 were reviewed.

Results: Majority of the patients were female (61.9%) and in the pediatric age group (57.1%). Of the 21 patients, 6 underwent medical management, 13 had surgical management, 1 had both medical and surgical management, and 1 opted to observe the lesion. All patients treated with propranolol observed a decrease in the size of the lesion. Seven out of the 13 patients had radiofrequency ablation; all had gross residual lesion. Six of the 13 underwent excision, with complete excision being achieved in 5 of 6 cases.

Conclusion: Treatment response of patients in this series with hemangiomas of the head and neck to propranolol at a dose of 1 to 2 mg/kg/day may reflect international data. Outcomes analysis for radiofrequency ablation and surgical excision requires a longer duration of follow-up.

 

Keywords: propranolol hydrochloride, prednisone, pulsed radiofrequency treatment, capillary hemangioma, vascular tissue neoplasms
Histopathologically Positive Regional Neck Node Metastasis Among Patients with Laryngeal Squamous Cell Carcinoma
Authors: Soliman Efren Gerald L. , Pontejos Alfredo Quintin Y.
Published: April 2019

Objective: To determine the patterns of regional neck node metastasis in laryngeal squamous cell carcinoma in Filipinos according to subsite and clinical stage, and to determine possible factors associated with level V involvement.

Methods:

            Design:           Retrospective Case Series

            Setting:           Tertiary National University Hospital

            Participants: A chart review was conducted for patients diagnosed with laryngeal squamous cell carcinoma who underwent laryngectomy with neck dissection from January 2011 to April 2015. Medical information obtained included demographics, clinical parameters, and histopathologic reports of nodal involvement. The rate and location of positive neck nodes was recorded according to clinical stage and primary subsite. Fisher exact test was used to determine significant risk factors for level V cervical lymph node involvement.

Results: Of 56 patients included, most were male with an average age of 61 years. Most patients had cancer originating from the glottic subsite, with the majority being staged III and IVA according to the TNM classification. Histopathologically positive neck nodes were centered at levels II to IV. No significant association was seen between level V involvement and the studied clinicopathologic factors (age, sex, tumor differentiation, subsite involvement, involvement of other neck node levels).

Conclusion: Cervical neck node levels II, III, and IV are the most commonly involved in neck dissection, with many being positive for nodal metastasis for these levels. Level V nodes may be removed when clinically positive, but elective neck dissection may exclude this level. The current practice of neck dissection appears to be appropriate in terms of selecting the most likely locations of metastatic spread. Further study is recommended, with a greater population and standardized levels of neck dissection.

Keywords:  laryngeal cancer, lymphatic metastasis, neck dissection, squamous cell carcinoma
Multiple Myeloma Presenting as a Parotid Mass
Authors: Borbe Benedick B. , Castaneda Samantha S.
Published: April 2019

Objective:       To present the case of a patient with left facial swelling as the primary manifestation of Multiple Myeloma, and discuss the surgical management, diagnostic dilemma, and subsequent medical management done for this unusual presentation.

 

Methods:

Design:           Case Report

Setting:           Tertiary Government Hospital

Patient:           One (1)

 

Results:           A 55-year old man with an enlarging left pre-auricular mass of one (1) year duration underwent superficial parotidectomy with facial nerve preservation and selective lymphadenectomy for pleomorphic adenoma based on initial clinical and cytologic findings. Histopathologic examination showed plasmacytoid proliferation, and subsequent work-ups finally revealed Multiple Myeloma.

 

Conclusion:    Emphasized in this case report is the thorough work-up and targeted therapy needed for the timely diagnosis and treatment of a patient with Multiple Myeloma.

 

Keywords: Multiple myeloma, plasmacytoma, parotid gland, pleomorphic adenoma
Tuberculosis of the Temporomandibular Region
Authors: Santos Jesusa M. , Reala Elias T.
Published: April 2019

Objective: To describe a unique case of extrapulmonary tuberculosis (TB) of the temporomandibular area focusing on its insidious and destructive course over a 2-year period with insights into the diagnostic and therapeutic pitfalls encountered throughout its clinical development.

 

Methods:

            Study Design:            Case Report

            Setting:                       Tertiary Government Hospital

            Patient:                       One

 

Results: A 33-year old man initially presented with right pre-auricular swelling and trismus that were unresponsive to antibiotic therapy. On subsequent follow-ups, initial symptoms were accompanied by a non-healing right pre-auricular wound, right ear discharge, trismus, and right facial paralysis (House-Brackmann III).  Cranial and temporal bone computed tomography scans revealed osteolytic destruction of the right temporomandibular region extending to the auditory canal and of the right mastoid bone extending to the right mandibular condyle and parotid. Infected malignancy of the parotid, mandible and temporal bone were considered, but definitive diagnosis from an incision biopsy revealed caseating granulomatous inflammation consistent with tuberculosis. He was started on anti-tuberculosis medications with significant resolution of pre-auricular swelling, non-healing pre-auricular wound, facial paralysis and ear discharge but minimal improvement in mouth opening.

 

Conclusion: Tuberculosis of temporomandibular region is rare and is associated with nonspecific manifestations. Delay in diagnosing and initiating appropriate treatment can lead to morbidity and serious complications involving destruction of the temporal bone, middle ear, mandible and parotid gland over its progression. A high index of suspicion by the physician and awareness of the patient’s health seeking behaviors could have aided in the early diagnosis and treatment of this extrapulmonary TB.

 

Keywords: tuberculosis, temporomandibular region, pre-auricular swelling, trismus, antituberculosis therapy, facial paralysis, chronic mastoiditis, ear discharge
Democracy and Social Conflict in Burma
Authors: Kouřil Michal
Published: April 2019

This article aims to evaluate the implications of the general elections inBurma in 2015 for the ongoing armed conflicts in this country. The article isconceptually based on Edward Azar’s theory of protracted social conflict.This theory was chosen because ethnic armed organizations in Burma havealways emphasized needs such as securing their own identity, security, andthe possibility of political participation, which are the main tenets of Azar’stheory. For the purposes of this article, a series of field studies in selectedlocations was carried out in the years 2016–2017. This research hascomplemented some of the previous findings of a number of authors whohave dealt with the region and has shown that the main obstacle to settlingthe conflict is the current Burmese constitution, which was issued in 2008by the former military government at the end of its reign.
ENHANCING BUSINESS PERFORMANCE OF CV. BERKAT ANUGERAH MALANG USING ONLINE MARKETING STRATEGIES
Authors: Gunawan Danny N. , Nailul F Ahmad Ihza , Andrianto Nicko , Schoonderbeek Wendy
Published: April 2019

CV. Berkat Anugerah is the company focussed on Packaging and Bottling industry. After the identification of the factors concerning the internal and external factors on the company. the repair was undertaken as well as an increase in the company's strategy. the latest strategy is integrated with various concepts in business management. the latest strategy developed at the company's focus to enter international markets especially in the Asian region. Improving Exposure, Adding the Target Markets, and Use Personal Seller On Abroad. the strategy drawn up by various considerations such as a competitive advantage and the risks that may be encountered by the company.
MALANG FLOWER CARNIVAL AS LAUNCHING PAD FOR FARIZ HOTEL MALANG
Authors: Chandra Gian Avila , Torres Andrea , Zacny Jessica A. , Aldrianita Thalita , Qadri Aisah Anugerah
Published: April 2019

Fariz is hotel located in a strategic place near airport and culinary spot.Currently the management of Fariz hotel do not think foreign tourist as a target market. Fariz hotel still lacks some resource to do an international promotion. Fariz hotel currently using online application and website to promote their service. Their current customer mainly is tour and travel or a company. Fariz hotel potencies are its strategic location and affordable price.

The team suggested a promotion program using Malang Flower Carnival as the theme. The program is a bundle package that use Malang Flower Carnival attractiveness to catch foreign tourist interest. This program is not only promote Fariz hotel but also promote Indonesian culture.Malaysia, China, and Australia are countries which both interested in Indonesian culture and have the most tourist visiting Indonesia. That countries are the main target for this promotion program. Fariz hotel management are agreed to do international marketing as long as the marketing program is makes sense and suitable with the current Fariz hotel situations. The team suggest that Fariz hotel should improve the English of their human resource, focusing their target segment, and participate in promoting Malang Flower Carnival.
The Impact of Implementation of the Regulation of Minister of Marine and Fisheries Number 56 and 57 of 2014 to the Fishing Industry in Bitung, North Sulawesi, and Indonesia
Authors: Rawung Stanny S , Rawung Ficke H
Published: April 2019

The fishing industry is the dominant driver of the Economy in Bitung. The major contribution of fishing industry to Bitung City made this city known by the term "Skipjack". With the enactment of the Regulation of the Minister of Marine and Fisheries No 56 of 2014 on Temporary Cessation (Moratorium) Licensing of Fish in Regional Fisheries Management of the Republic of Indonesia and the Regulation of the Minister of Marine and Fisheries No. 57 of 2014 regarding the Second Amendment to the Regulation of the Minister of Marine and Fisheries No. 30 / MEN / 2012 on Business fisheries Regional fisheries Management in the Republic of Indonesia., brought a huge impacts for the fisheries industry in Bitung. The implementation of the new fishing regulation did not only affect the fishing industry in Bitung, but also throughout the economy on the city of Bitung and North Sulawesi. This research analyzed the impact of the application of the regulation. In this study, the researchers examined the Fishing Industry Bitung city before and after implementation of the fishing regulation. The study also included the analysis of the fish/raw material supply chain which most severely affected by the new fishing regulation and also discuss the multiplier effects from the application of the fishing regulation.
Diseño y construcción de un prototipo para control y monitoreo de reservorios de agua con el empleo de comunicación móvil GSM/ GPRS en sistemas de riego
Authors: Miranda Ruiz Helen , Altamirano Gustavo Chafla
Published: April 2019

La agricultura en el Ecuador es esencial, no solo culturalmente sino económicamente ya que aporta aproximadamente un 6.47% al valor agregado bruto {VAB} nacional. A nivel de provin- cias para territorios como Los Ríos, Bolívar y Cotopaxi, representa hasta el 36% de su VAB. En promedio, la producción bajo riego contribuye al 70% de la producción agrícola nacional, pero la presencia de los cambios climáticos, la ausencia de asistencia técnica, la poca tecnificación en la infraestructura de los sistemas de riego, han provocado un mal manejo del recurso hídrico. Por tal razón, este proyecto tiene como objetivo implementar un sistema que permita optimizar el uso del recurso hídrico e innovar tecnológicamente la infraestructura existente, en reservorios de riego. El sistema es un prototipo en el que de forma automática se controla el nivel de agua que ingresa a un reservorio, evitando un desperdicio del líquido. El sistema también permite controlar automáticamente el mecanismo de distribución de agua hacia los usuarios mediante una interfaz de comunicación móvil {GSM/GPRS} que habilita a un administrador remotamente activar o inter- rumpir la distribución del agua de riego. Proporciona además opciones de monitoreo y recepción de alarmas para verificar su funcionamiento, efectuando una gestión eficiente del recurso hídri- co maximizando los beneficios y alcanzando un desarrollo económico y social respetuoso con el medio ambiente.
High-throughput SPE-LC-MS/MS method for determination of indapamide in human serum
Authors: Nakov Natalija , Mladenovska Kristina , Zafirov Dimche , Dimovski Aleksandar , Petkovska Rumenka , Dimitrovska Aneta , Kavrakovski Zoran
Published: April 2019

Simple, automated SPE procedure combined with fast LC-MS/MS chromatographic separation resulted in obtaining high-throughput LC-MS/MS method for determination of indapamide in serum. The SPE procedure was performed on polymeric mixed-mode sorbent and the analytes were quantitated using electrospray ionization in positive mode. The recovery of indapamide and internal standard were 89.25- 90.36% and 79.10%, respectively. Experimentally it was confirmed that the matrix effect had a negligible effect of ionization efficiency. The validation data showed that the proposed method provides accurate and reproducible results in range of 0.50-50 ng/mL. In addition, a comparison was made between the method for determination of indapamide in serum and in blood (develop in our previously work) regarding the extraction procedure and matrix effect.
MORPHOLOGY OF INTRAVASCULAR AUTOROSETTES AT HEALTHY CHILDREN
Authors: Korichkina L N , Yesipova A V , Zhmakin I A
Published: April 2019

The purpose of the study was to evaluate the morphological types of autorotation (AR) in the peripheric blood in children under the influence of outdoor air pollution. Material and methods. 613 students of I-II health groups under ordinary life conditions were surveyed. They were divided into 2 groups depending on the index of atmospheric air pollution on the schoolyards. In blood smears (stained with Romanovsky-Giemsa) AR number was counted and determined their morphological types and the morphology. The modification of red blood cells was evaluated. Results. It was stated that with increase of the air pollution index the intensity of autorosette-formation (ARO) in the blood increased. AR morphotype depends on the nature of rosette cells (leukocyte), to which at least three modified autologous erythrocytes are tightly fixed. Leukocytal AutoRotate formed by neutrophils, monocytes, eosinophils, basophils, and large, medium and small platelet aggregates were distinguished. Conclusions. Contaminated atmospheric air is a risk factor for the health of children and adolescents. AR morphotype depends on the nature of the rosette cells. The frequency of the ARC in the peripheral blood grows with increasing number of modified red blood cells. Further research is needed in this area.
EXPERT ENVIRONMENTAL ASSESSMENT, SPECIFIC FOR INDIGENOUS PEOPLES OF SIBERIAN ARCTIC (ON THE BASIS OF KRASNOYARSK REGION)
Authors: Koptseva N P
Published: April 2019

The article presents the results of long-term (2010-2016) integrated field studies in the Siberian Arctic, the Krasnoyarsk Territory, that is densely populated with indigenous peoples (Evenki, Evens, Selkups, chum, Dolgans, Nenets, Chulyms). All the world's indigenous peoples are particularly vulnerable in situations of global transformation and urbanization. Indigenous peoples of the Siberian Arctic live in areas that are actively being reclaimed by modern mining companies. The cultural heritage of indigenous peoples includes the unique biological and socio-ecological practices connected, in particular, with the domestic nomadic reindeer breeding. The author of the article organized the Delphi - survey of 127 experts, for which a special questionnaire has been developed, including issues, critical situations, critical technologies that are typical for Siberian Arctic, where indigenous peoples live. It is possible to model three main scenarios of the environmental situation of indigenous peoples of Siberian Arctic based on analysis of the experts' responses. The main conclusions of the experts, which included representatives of the North and Siberian indigenous peoples, connected with the greatest probability of the pessimistic scenario, according to which environmental risks would increase, and the cultural heritage of indigenous peoples would disappear together with its carriers. The development of environmental rights of indigenous peoples and special efforts to preserve the unique environmental practices in areas of traditional nature (TTN) is necessary for overcoming the pessimistic scenario. At the same time, a modern legislative framework for the formation of TTN in the Krasnoyarsk region is virtually absent. It is recommended to improve the legislative framework in the field of environmental law as well as the intensification of strategic partnership between the civil society organizations of indigenous peoples of Siberian Arctic and representatives of mining companies working in that region.
GESTATION-SPECIFIC LIVE-BORN TWIN BIRTH WEIGHT, LENGTH AND HEAD CIRCUMFERENCE PERCENTILES AND CURVES ADAPTED FOR NORTH-WESTERN RUSSIA
Authors: Usynina A A , Postoev V A , Odland Jon Øyvind , Chumakova G N , Grjibovski A M
Published: April 2019

Until now, national percentiles and curves for twins based on population registry data have not been published. It complicates the diagnosis of fetal growth retardation. In the article, the algorithms of birth weight, length and head circumference percentiles and curves for twins born alive at gestational age 32-40 weeks are described. We used data from the population-based Murmansk County Birth Registry (2006-2011) and the Arkhangelsk County Birth Registry (2012-2014), Russian Federation. Data on 1 567, 1 631 и 1 628 newborns were used to create birth weight, length and head circumference percentiles, respectively. Gestational-specific curves present data on 10th, 50th and 90th percentiles. Mean birth weight and head circumference in males were higher compared to corresponding parameters in females at any gestational age. At 32 weeks of pregnancy mean birth length in females was higher compared to length in males. In our current study, the database was comprehensive enough to be representative for the population. Conclusively, the results of the study will be valuable for clinical practice across other regions of the Russian federation.
Voices from the Field
Authors: Bacharach Nancy , Heck Teresa Washut
Published: April 2019

Teacher preparation programs face continued scrutiny and to address these concerns it is imperative that teacher educators examine all aspects of their current preparation programs. The student teaching experience is a critical component in teacher preparation, and must undergo careful review. The SCSU co-teaching model provides a proven alternative to the traditional student teaching experience. This model not only strengthens university/school partnerships, but also has the ability to provide benefits for all stakeholders.
Why didn’t anyone tell us what it would really be like?
Authors: Greinke Russell
Published: April 2019

Historically, teacher retention has been a more significant issue than teacher recruitment. This study looks at how teachers become “comfortable in their own skin.” To be successful in their chosen careers, teachers undergo a process of Teacher Identity Formation that blends one’s educational philosophy, teaching style, and personality. Finding one’s own voice, one that is less imitative of influential teachers from one’s past, occurs in those “Borderlands” where the personal and the professional meet, where who you are as a person and who you are as a teacher coalesce. Via an interview-based phenomenological study, this paper uses the cumulative wisdom of successful, experienced teachers to look at how they ultimately make sense of their position and overcome obstacles to identity formation. The findings may offer guidance to new teachers and teacher educators.
The Free Base Extraction of Harmaline from Penganum harmala
Authors: Brobst Alyssa , Lewis Jeremy , Klett Brian , Haustein Cathy , Shriver James
Published: April 2019

Highly fluorescent and pharmaceutically significant Harmala alkaloids occur in several plants including Syrian Rue (Penganum harmala) and several species of passion flowers. We identified a relatively nontoxic and efficient method for extraction of the major harmala alkaloid components from Syrian Rue seeds using ethyl acetate and sodium bicarbonate. This produced free base harmala alkaloids. Verification was performed qualitatively by using High Performance Liquid Chromatography and NMR analysis.
KBO Astrometry Using Small Telescopes
Authors: Bowens-Rubin Rachel , Decker French Katheryn , Gao Dora , Jaworsky Christina
Published: April 2019

CCD images of Makemake (2005 FY9), the second largest Kuiper Belt Object (KBO), were taken with a 14-inch telescope during the summer of 2008. The position of Makemake was found by comparing its position on the frames to UCAC2 stars in the frame. Observations were limited by the tracking capabilities of the telescopes and atmospheric limitations. The average right ascension offset from the ephemeris was found to be 0.0134 0.3394 arcseconds, and the average declination offset was found to be -0.3855 0.4634 arcseconds. It is possible to do KBO astrometry with small telescopes, however several hundred frames are required to equal the quality of observations on larger telescopes.
Odor and the Effects of Schema Activation on Recognition Memory
Authors: Appino Kelly , Svec Claire , Tankard Brandon , Overman Amy , Stephens Joseph
Published: April 2019

This study investigated whether schema-consistent odors affect recognition memory. Forty-two undergraduate students read a story about baking in the presence of an odor that was either baking-related (schema-consistent) or not (schema-inconsistent). Further, the story contained information that was both inconsistent, and consistent, with baking. Participants were then tested on recognition of information from the story. It was predicted that participants who smelled the schema-consistent odor would be more likely to falsely recognize new (i.e., not in the story) schema-consistent information than those who smelled the schema-inconsistent odor. The results indicated that all participants were more likely to falsely recognize new schema-consistent information than schema-inconsistent information. However, odor had no statistically significant effects on recognition.
Metal Ion Concentration within Algal Tissue of Species Growing in Proximity to Tioga River Outflows Affected by Acid Mine Drainage in Northern Pennsylvania
Authors: McKibbin Cheyenne , Root Kyle , Carson Gregory
Published: April 2019

In this study, two species of algae from two different areas impacted by acid mine drainage (AMD) were analyzed for metal ion accumulation. The two species of algae collected were Klebsormidium and Entransia. Both algal species are located in an area of high metal ion concentrations and low pH (ranging from 2.28 to 2.89). The study assessed the concentration of iron, manganese, zinc, copper and nickel in the algal tissue. Data shows that both Entransia and Klebsormidium are absorbing or adsorbing iron selectively.