bluuebunny/crossref_metadata_2025 huggingface dataset:
PXR mediated cardiac protection after sepsis through TLR4 modulation pathway
Authors: Huska Seth F. , Ade Michelle H. , Zhou Ainara
Published: October 2020

Cardiac dysfunction is a vital component of multi-organ failure during severe sepsis. The primary function of pregnane X receptor (PXR) is to sense the presence of foreign toxic substances and in response up regulate the expression of proteins involved in the detoxification and clearance of these substances from the body. Further, Toll-like receptor 4 (TLR4), the signal-transducing molecule of the LPS receptor complex, plays a fundamental role in the sensing of LPS from Gram-negative bacteria. Activation of TLR4 signaling pathways by LPS is a critical upstream event in the pathogenesis of Gram-negative sepsis, making TLR4 an attractive target for novel antisepsis therapy. TLR4 mutant (TLR4-/-) and wild type TLR4 (TLR4+/+) mice underwent a sterile (lipopolysaccharide; LPS) or infectious (Streptococcus pneumoniae or Klebsiella pneumoniae) septic challenge. Production of cytokines, TNF, IL-1β, IL-6 and IL-10, in the blood and from cardiomyocytes was exaggerated in the TLR4+/+ mice compared to responses measured in mutant TLR4-/- type mice given an identical septic challenge. This enhanced compartmentalized myocardial inflammation was associated with significantly decreased cardiac contraction and diminished relaxation in the TLR4+/+ mice. Furthermore, PXR expression has critical role in down-regulation of sepsis via TLR4 pathway, and more reduction in cytokines, improved myocardial function in PXR+/+suggesting that PXR was a major cause of the greater myocardial contractile improvement in TLR4-/- mice. Taken together, our results suggest that PXR plays a role in the down-regulation of myocardium during sepsis. Further studies are warranted to further define the precise mechanisms of PXR mediated cardiac protection.
Validation of the appendicitis inflammatory response score in a provincial population
Authors: Fagan Paul V. B. , Stanfield Brad , Korduke Olga , Henderson Nigel , Kodeda Karl
Published: October 2020

Background: The appendicitis inflammatory response (AIR) score is a high performing, and easy to use clinical prediction tool for the evaluation of appendicitis, but its efficacy has not been studied in the provincial setting. This retrospective, single centre study aims to validate the AIR score, estimate the effect AIR score-based risk stratification would have on the negative appendicectomy rate and compare it against other well-known clinical prediction tools for appendicitis.Methods: 425 patients treated with appendicectomy or laparoscopy between 1st Jan 2015 and Dec 31st 2017 were retrospectively provided with an AIR score. This score was compared against the final macroscopic and histological results to determine its accuracy in the local population.Results: The AIR score did not perform as well as in other published series, with an area under the receiver operating characteristic curve (AUC) of 0.836. The AIR score performed favourably in comparison to the Alvarado score (0.761), APPEND score (0.747) and adult appendicitis score (AAS) (0.828).Conclusions: This study showed that the AIR score has a high accuracy, and validates its use in a provincial setting. AIR score-based management of appendicitis would be expected to reduce non-therapeutic explorations by a minimum of 50%.
Surgical management of traumatic pancreatic injuries and their consequences.
Authors: El-badry Ashraf Mohammad , Ali Mohamed Mahmoud
Published: October 2020

Background: Management of pancreatic trauma remains challenging due to difficulty in diagnosis and complexity of surgical interventions. In Egypt, reports on pancreatic trauma are scarce.Methods: Medical records of adult patients with pancreatic trauma who were admitted at Sohag University Hospital (2012-2019) were retrospectively studied. Patients were categorized into group A of non-operative management (NOM), group B which required upfront exploratory laparotomy due to hemodynamic instability and group C in which surgical management was implemented after thorough preoperative assessment. Pancreatic injuries were ranked by the pancreas injury scale (PIS).Results: Thirty-two patients (25 males and 7 females) were enrolled, and median age of 36 (range: 23-68) years. Twenty-eight patients (87.5%) had blunt trauma whereas penetrating injury occurred in 4 (12.5%). There were 9 patients in group A, 7 in group B and 16 in group C. High grades of pancreatic injury ≥3 occurred in 4 patients from group B and 5 from group C. Distal pancreatectomy was performed in 7 patients while central resection and panceatico-gastrostomy in one. Grade IV injury occurred only in one patient who received damage-control laparotomy. Post-operative complication were significantly increased in group B compared with C, in correlation worse hemodynamic status and increased severity of PIS. Post-operative mortality occurred in 2 patients (6%), both from group B. Late consequences included pancreatic pseudocyst (4 cases) and walled off pancreatic necrosis (2 cases).Conclusions: High grades of pancreatic injury and hemodynamic instability correlate with worse outcome after surgery for pancreatic trauma.
Factors affecting temporary stoma outcomes at a major Saudi University Hospital
Authors: Nassif Mohammed O. , Trabulsi Nora H. , Farsi Ali H. , Al-shammakh Sonds S. , Alghamdi Ibtihal O. , Alshehrani Esraa A. , Alotaibi Shayma M. , Habeeb Razan A. , Akeel Nouf Y. , Malibary Nadim H. , Saleem Abdulaziz M. , Kadi Mai S. , Badahdah Al-Mamoon
Published: October 2020

Background: Temporary stoma formation for fecal diversion is commonly performed in surgery. The rate of stoma-related complications is high, and the risk increases in patients with prolonged time to closure. Thus, identifying factors that influence the time to stoma closure and the rate of its complications would aid in implementing preventive measures. We aimed to determine predictors affecting the time to stoma closure and to identify risk factors for developing complications following stoma reversal.Methods: A retrospective review including all adult patients who underwent stoma closure from 2012-2018 at our institution was conducted. Multivariate regression analysis was used to determine risk factors affecting time to stoma closure and developing complications after reversal surgery.Results: A total of 63 patients were included. Of those, 50.8% were diagnosed with malignancy. The median time to stoma closure was 222.5 days (interquartile range i.e. IQR 12-2228).Having an American society of anesthesiologists (ASA) class IV was the only significant predictor of prolonged time to closure. For cancer patients, developing complications following stoma formation surgery, and receiving adjuvant therapy significantly increased the time to stoma reversal. In contrast, cancer patients who underwent multi-organ resection had shorter time to closure. The rate of complications following stoma reversal was 30.2%. Having a colostomy and requiring readmission after stoma formation surgery increased the risk of developing complications related to stoma reversal.Conclusions: Multiple factors can impact the time to stoma closure and increase the risk of developing complication related to stoma closure. Awareness about these factors and development of preventive strategies is recommended.
Hyperbaric oxygen therapy as an adjunctive treatment for descending necrotizing mediastinitis: about 6 cases
Authors: Hazem Zribi , Abdulrehamen Ammar , Amina Abdelkabir , Ahmed Ben Ayed , Ameny Touil , Adel Marghli
Published: October 2020

Background: The objective study was to evaluate the use and the effectiveness of hyperbaric oxygen therapy as an adjuvant therapy in 6 cases of descending necrotizing mediastinitis.Methods: This is a retrospective descriptive study, performed between 2010 and 2019. Hyperbaric oxygen therapy was indicated in difficult clinical management cases despite surgery and antibiotic therapy.Results: Six patients had oxygen therapy sessions in addition to antibiotic treatment and surgery. There was marked clinical and radiological improvement in 5 cases. Only one patient died in a septic shock.Conclusions: Hyperbaric oxygen therapy, as adjuvant therapy to surgery and antibiotic treatment, can increase survival and provide good clinical results.
A prospective study of 50 cases of laparoscopic intestinal anastomosis by Endo GIA universal loading stapler (green/blue) versus Endo GIA articulating reload with tri staple technology (purple)
Authors: Vasaiya Mehulkumar K. , Shah Samir M. , Gohil Vikram B. , Vaghasia Milankumar S.
Published: October 2020

Background: Intestinal anastomosis is a commonly performed procedure in surgery. Various evolvements have occurred in the field of intestinal anastomosis and recent advancement is the use of stapler in laparoscopic surgeries as a device for Gastrointestinal (GI) anastomosis. Few previous studies evaluating the clinical safety of the 2 laparoscopic linear stapling devices are available.Methods: A prospective comparative study of 50 cases which met the inclusion and exclusion criteria were included in this hospital-based study. They were randomly allocated to two groups, Group A which underwent laparoscopic intestinal anastomosis by Endo GIA tri-staple (purple) stapler and Group B which underwent Endo GIA universal loading unit (blue/green) stapler. Primary outcome was assessed in terms of intra-operative staple line bleeding, operative time and post-operative anastomotic leak.Results: Patients with laparoscopic intestinal anastomosis by Endo GIA tri-staple stapler (purple) have required less operation time as compared to Endo GIA universal loading unit. In Endo GIA universal loading unit (blue/green) 04% patients developed anastomotic leak and 40% patients had intra-operative staple line bleed while with Endo GIA tri-staple no postoperative anastomotic leak was found and 02% patients developed intra-operative staple line bleeding.Conclusions: The result of our study has shown that the Endo GIA reload tri- staple (purple) is superior in terms of having no anastomosis leak, negligent staple line bleeding and less operation time as compared with Endo GIA universal loading unit (blue/green). Thus, laparoscopic intestinal anastomosis by Endo GIA reload tri-staple stapler (purple) technology is more effective and overall more efficient.
Role of streptokinase in management of retained hemothorax: a multicentric study
Authors: Varma Ankur , Narain Ravikant , Deshmukh Parag , Rathore Himmat , Datta S. G. S. , Varma Aditi V. , Sharma Pawan , Joseph Jebin
Published: October 2020

Background: Enzymatic debridement of the pleural cavity for retained haemothorax is a frequently overlooked option.Methods: A retrospective, multicentre study was carried out using intrapleural streptokinase was carried out in 15 patients with retained or clotted haemothorax.Results: Thirteen of fifteen patients (86%) with retained pleural collections underwent successful enzymatic debridement and tube drainage with streptokinase injections in our study. The average increase in chest tube output following streptokinase injections was 160%. No significant adverse reactions occurred. Two patients required thoracotomy when streptokinase therapy failed. No deaths were reported in the study.Conclusions: Intrapleural streptokinase is a safe, effective means of removing retained proteinaceous collections in the pleural space. It is a useful adjunct to chest tube drainage and may obviate the need for more invasive procedures.
Three port versus four port laparoscopic cholecystectomy: a prospective comparative clinical study
Authors: Chauhan Harish , Kothiya Jenish , Savsaviya Jignesh
Published: October 2020

Background: Although, traditional laparoscopic cholecystectomy is performed using four-port technique, various modifications were made to further enhance the advantages of laparoscopic cholecystectomy. Aim of the study is to compare the results of three-port and four-port laparoscopic cholecystectomy at single centre in terms of technical feasibility, safety of the procedure, operative time, intra-operative complications, postoperative pain and post-operative analgesia requirement.Methods: It was a prospective comparative study conducted in the department of surgery Smimer medical college Surat, India from July 2018 to July 2019. The study was performed on all adult patients with ultrasound documented cholelithiasis. The total number of patients studied was 50 which were divided into two groups of 25 each.Results: Demographic data were comparable for both study groups. Patients in the 3-port group had shorter mean operative time (47.3±29.8 min versus 60.8±32.3 min) for the 4-port group (p=0.04). Post-operative requirement of analgesia was less in 3 port group as compared to 4 port group. Pain visual analog scale (VAS) score, intra operative complications, post- operative complications and return to normal activity were significant in our study. Hospital stay and patient satisfaction were non- significant.Conclusions: The three-port technique is as safe as the standard four-port technique and can be a viable alternative to four port cholecystectomy with an advantage of less analgesic requirement, early post-operative ambulance, early oral feed, and better cosmetic results.
Evaluation of relaparotomy in surgery and obstetrics and gynecology patients in tertiary care hospital in India: reason, morbidity, mortality: a case controlled study
Authors: Shah Pooja , Choksi Dilip , R. Arun , Chauhan Sahdev , Kadia Ronak
Published: October 2020

Background: Many laparotomy may require relaparotomy due to post-operative complication as life-saving procedure. Incidence of relaparotomy and post-operative outcome defers from patient to patient. The objectives of our study were to evaluate the indication of relaparotomy, outcome of the relaparotomy and factors affecting mortality.Methods: Data was collected between March 2017 and November 2019 in SSG hospital, Vadodara. Patient’s demographics, indication and intra-operative findings of initial surgery and relaparotomy with morbidity and mortality were studied. Patients from department general surgery and obstetrics and gynecology were included. Consent was taken in a pre-validated form.Results: Out of total 5684 laparotomy performed, 146 (2.58%) patients underwent relaparotomy. Male to female ratio was 1.5:1. Incidence was highest in 31-40 years age group (median age: 37 years). Dirty wound in initial laparotomy had highest conversion rate (3.21%) to relaparotomy. Mean interval between initial laparotomy and relaparotomy was 8.57±5.62 days. The major indication of relaparotomy was burst abdomen (39.52%) followed by leak from previously sutured site (24.65%). 50.68% patients were shifted to ICU following relaparotomy. Average days of ICU admission were 4.16±2.25 days. Mortality rate was 23.29%. Maximum mortality was noted in case of leak from anastomotic or perforation site. 14 (38.88%) deaths occurred during postoperative day second to fourth with mean hospital stay of 21.85±8.65 days.Conclusions: Although relaparotomy is life-saving procedure, it has high mortality rate. The possibility of efficiently lowering relaparotomy depends on success of the first laparotomy, patient’s status, early re-exploration with proper surgical techniques and thorough postoperative care.
Prospective comparative study of modified Smead Jones versus conventional continuous method of fascial closure in emergency midline laparotomy
Authors: Aghara Chirag B. , Rajyaguru Ajay M. , Bhatt Jatin G.
Published: October 2020

Background: A midline incision is simple, quick, bloodless and provides excellent exposure. So it is most commonly used access route for emergency laparotomy. But compare to other incision it increases incidence of postoperative wound dehiscence and an incisional hernia. Prevention of this complication is important in reducing post-operative morbidity and mortality. Present study was undertaken to compare the effectiveness of modified Smead Jones versus conventional continuous closure technique in terms of wound infection and wound dehiscence.Methods: A total of 100 patients from July 2017 to November 2019 were randomized in two groups of 50 each. Group A in which linea alba closure was done by modified Smead Jones technique and group B in which linea alba closure was done by conventional continuous closure technique.Results: 12 patients in group A and 28 patients in group B developed wound infection and 1 patient in group A and 7 patients in group B developed wound dehiscence.Conclusions: Modified Smead Jones technique is better than conventional continuous closure technique in management of closure of emergency midline laparotomy.
Predictors of successful trial with-out catheter following acute urinary retention secondary to benign prostatic hypertrophy
Authors: Jha Aditya A. , Singh Gagandeep , Govindaiah Madhu , Solanki Nimit
Published: October 2020

Background: Acute urinary retention (AUR) is one of the most psychologically distressing complications of benign prostatic hypertrophy (BPH). Attempt of trial without urinary catheter (TWOC) is given to all these patients, failing which they are subjected to surgical management. This study was conducted to analyse the possible predictors of successful trials in such patients.Methods: Patients reporting to our centre with a first episode of spontaneous AUR secondary to BPH were enrolled. Following per-urethral catheterization residual urine volume (RUV) drained, duration of symptoms and international prostate symptom score (IPSS) were recorded. Using trans-abdominal ultrasonography (USG) prostate volume (PV), intra-vesicle prostate protrusion (IPP) and bladder wall thickness (BWT) were measured. Catheter free trial was given after a course of tamsulosin. Success was defined if patients could void >200 ml of urine within six hours of catheter removal with a maximum flow rate of >5 ml/sec and achieved a post void residual (PVR) urine volume of <150 ml.Results: Ninety patients with 58 in successful and 32 in failed group were analysed. Significantly lesser age, IPSS, RUV, IPP and BWT was noted in successful group. Duration of LUTS and PV on USG were statistically insignificant parameters in determining a successful trial.Conclusions: Age, IPSS, RUV, IPP and BWT may have a role in predicting successful TWOC following AUR secondary to BPH.
Study to assess neuropathy severity in patients with diabetic foot problems
Authors: Narayana Someshwara Rao Pallela
Published: October 2020

Background: Diabetic neuropathy is the most common complication of diabetes affecting 50% of the patients with type 1 and type 2 diabetes. Its late sequelae which include foot ulceration, charcot neuroarthropathy and occasionally amputation, should in many cases be preventable. Biothesiometry is a device which can measure the vibration perception threshold and guide the treatment as well as prevent further foot problems in such patients.Methods: In this study we included 65 patients with diabetic foot symptoms by random sampling technique between the age group of 40-75 years. All these patients were subjected to biothesiometer testing. The response was measured as vibration perception threshold (VPT). The variation of VPT in different conditions was established.Results: Among 65 patients, 40(61%) patients had painful sensation, VPT ranging from 16 V to 25 V, 6 (0.09%) patients had callus, dry foot or pigmentation with VPT 25-35 V, 12 (18.4%) patients had callus ulcer with VPT 36-45 V, 3 (0.046%) patients had both ulcer and skin changes with VPT 45-50 V and 4 (0.06%) patients presented with deformity and VPT 50 V.Conclusions: The study concluded that risk of ulceration is high with increased VPT. Hence, early detection of raised VPT would help the clinicians not only to guide the patients about the high risk of ulceration but it as well will help in educating the patient and emphasizing the need for proper glycemic control, proper footwear and foot care.
Varied uses of bone allograft in plastic and reconstructive surgery
Authors: Singh Vikas , Dang Shivam
Published: October 2020

The availability of safe, clinically useful and cost effective bone allografts have resulted in changes in surgical treatment with a concomitant increase in demand for bone allografts grafts for the purpose of reconstruction in plastic surgery. They offer an attractive alternative to bone autograft because their supply is less limited, they allow structural restoration of the skeleton, and their surfaces support bone formation. We report a case series of 13 patients where freeze dried bone allografts were used for reconstruction. All grafts met standards recommended by the Bone Banks and the FDA. Objective evaluation of the persistence of graft volume was obtained by radiography, whereas subjective estimation of graft volume was obtained by patient response on regular follow up upto a period of one year. Bone allografts can be used in any kind of surgery involving bone from minor defects to major bone loss after tumour resection. Freeze-dried allograft bone is a safe and equal alternative for bone autograft without donor-site morbidity.
Duplicated appendix with an acute abdomen in 16 years old female with both appendices inflamed: a rare case report
Authors: S. Shivakumar , Kumar Uday
Published: October 2020

Duplicated appendix is a rare congenital anomaly with incidence of 0.004-0.009% and its mostly an incidental finding on table, when one of them is acutely inflamed and very rarely both of them can be inflamed as in this case. Report a case of young girl who presented with complain of pain abdomen and vomiting in the last 2 days. Clinically patient was diagnosed to have acute appendicitis and on laparoscopy, patient had duplicated appendix one at the ileocaecal valve and the other 2cm away near the caecum with pus and faecolith. Histopathology confirmed appendicitis in the both appendices. Reported about this interesting rare case because even though the incidence of duplicated appendix is too low (0.004-0.009%), should always search for the missed appendix in patients who underwent appendicectomy earlier and complains of severe pain in right iliac fossa. Aim was to report such a rare interesting case and give a small gentle reminder to the surgeons as duplicated appendix even though rare but still a possibility.
Management of presacral retroperitoneal schwannoma: highlighting the various features
Authors: Dhangar Sanjay P. , Baste Nitin , Murumkar Sandeep P. , Shengal Manisha
Published: October 2020

Schwannomas are relatively rare tumours. They occur in approximately 1 of 40,000 hospital admissions. Usually asymptomatic unless very big in size. They may present with symptoms of visceral compression viz. constipation, urinary frequency and urgency, or the nerve compression like sciatica, lower extremity weakness, tingling and numbness. We here highlight the various clinical, radiological and pathologic features the tumour and importance of proper pre-operative imaging, planning regarding surgery and the type of consent required before the surgery in a 30 years old male with a large pelvic mass, diagnosed and supposed to be Schwannoma arising from the S2 sacral foramina. We were able to enucleate the mass intact without any visceral or neuro-vascular injury with minimal blood loss.
Different outcomes of spontaneous gall bladder perforation owing to timing of surgical intervention: report of 2 cases
Authors: Dakhani Nawaz M. , Lamani Yamanur P.
Published: October 2020

Gall bladder perforation (GBP) is a rare life-threatening complication with a high mortality due to atypical clinical presentation and delay in diagnosis due to atypical clinical presentation. Case report 1, 70-year-old female presented with complaints of pain abdomen, vomiting and blackish pigmentation over abdomen since a week. She was in shock on presentation, with necrotic patch over abdomen and abscess collection at umbilicus. Ultrasound revealed GBP at fundus with thick collection in gastrohepatic recess with overlying abdominal wall cellulitis. CECT was not possible and the patient could not be taken for surgery due to unstable vitals and expired the next day. Case report 2, a 68-year-old male presented with complaints of pain abdomen over right side with vomiting. Abdomen was tender diffusely with guarding in right hypochondrium. Ultrasound showed distended gall bladder (GB) with multiple calculi. Magnetic resonance cholangiopancreatography (MRCP) showed a GBP at fundus with pericholecystic collection extending into hepatogastric recess. He underwent total cholecystectomy and post-operative period was uneventful. Acute cholecystitis has a perforation rate of 2-11% due to cystic duct obstruction, ischemia and necrosis. Our first patient had type-III GBP and was in shock and did not survive due to bad condition on arrival whereas the second patient had type-I GBP and underwent cholecystectomy without any complications. Type-I and type-II GBP as proposed by Niemeier have better outcomes compared to type-III. Rapid diagnosis and surgical intervention are very much necessary for reducing mortality as they rarely present with typical signs and symptoms of perforation.
An uncommon case of anterior mediastinal teratoma
Authors: Sekar Soorya C. , Maydeo Rohan A. , Kasliwal Navin , Mandhane Anirudha
Published: October 2020

Germ cell tumors (GCT) are commonly seen in both children and young adults. Teratomas are a form of GCT and histologically contain tissues derived from all three germ cell layers. These tumors can exhibit malignant behaviour, hence should be diagnosed and treated as early as possible. So, hereby present a case of 18-year-old female who presented with complaints of fever and cough with gradual onset from 20 days. A chest X-ray revealed growth in the left side of the chest. A high-resolution computed tomographic (HRCT) scan of the chest showed a large well-defined hypodense lesion in the left hilar region. Bronchoscopy showed extrinsic compression in the left main bronchus. The patient underwent anterolateral thoracotomy to remove a 9×9 cm mass lying in the mediastinum resting on pericardium. The histopathology specimen turned out to be a mature teratoma. This interesting case is described with its incidence, diagnosis and management protocols for the mediastinal teratoma.
An unusual presentation and management of incarcerated Richter’s type of Spigelian hernia: a rare case report and review of literature
Authors: Ravi Prabhu , Rajebhosale Ramprasad , Husain Najam
Published: October 2020

Spigelian hernias (SH) are one of the rare forms of ventral abdominal hernias which constitutes about 1-2%. SH occurs through the defect in the anterior abdominal wall adjacent to the semilunar line which occurs in the lower abdomen where the posterior sheath is deficient. The usual presentation of SH is a painful mass in mid abdomen above anterior superior iliac spine (ASIS). The diagnosis is made by means of ultrasound and computed tomography (CT). We report 69 years old female who is a known case of Parkinson’s disease and on medication presented with 2 days of sudden-onset right iliac fossa (RIF) associated with intermittent nausea, vomiting and also abdominal distension. O/E: Abdomen soft, tenderness in RIF with swelling above the line of ASIS. With the diagnosis of lateral abdominal wall hernia we took a CT scan that shows obstructed SH. Immediately she underwent surgery, intra-operative picture shows intraparietal hernia with Richter’s type and viable bowel. Abdominal wall is very weak and flimsy with no proper differentiation between the layers. Preperitoneal mesh repair was performed. The post-operative (post op) period was uneventful. Till now there was only 6 type of Richter’s SH reported. In this article we discuss a brief knowledge of SH and the management part of SH. We hope that this article will benefit among the surgeons in treating with SH.
Assessment of the outcome of myringoplasty with cortical mastoidectomy in dry and wet mucosal type of chronic otitis media
Authors: Balan Sreeshma , D. Prakash M.
Published: October 2020

Background: Chronic otitis media (COM) is an inflammatory process in the middle ear space that results in long-term changes in the tympanic membrane including atelectasis, dimeric-membrane formation, perforation, tympanosclerosis, retraction pocket or cholesteatoma. COM can be classified into healed, inactive (mucosal or squamosal), active (mucosal or squamosal). Myringoplasty is tympanoplasty without ossicular reconstruction. Cortical mastoidectomy is usually accompanied by tympanoplasty. Aim was to assess and compare the efficacy of myringoplasty with cortical mastoidectomy in dry and wet mucosal type of COM, in terms of graft uptake and hearing improvement.

Methods: A prospective study, where 30 patients each of wet and dry mucosal-type COM were included. Patients underwent myringoplasty with cortical mastoidectomy. All were followed up for 6 months, both the groups were statistically compared.  

Results: In our study, mean age of patients in group A (wet COM) was 34.13 years and group B (dry COM) was 33.36 years. Group A had success rate of 90% and group B had success rate of 86.6%. There was no statistical significance (p value- 0.53) on comparing both groups with respect to graft uptake. There was significant hearing improvement post-operatively in both the groups (p<0.05). However, there was no significant difference between the groups (p value- 0.66). This shows that presence of discharge at the time of surgery does not interfere with the results of cortical mastoidectomy with myringoplasty.

Conclusions: We conclude that, there is good outcome in both wet and dry COM following myringoplasty with cortical mastoidectomy with respect to graft uptake and hearing improvement.
Study of the effect of balloon sinuplasty in patients with rhinosinusitis
Authors: Singh Tanya , Singh Arjun , Singh Sarbjeet
Published: October 2020

Background: A new technique which has revolutionized sinus surgery recently is balloon sinuplasty. The vast majority of patients with chronic rhinosinusitis improve with medical management, including antibiotics, saline irrigation, nasal steroids, antihistamines, allergy therapy, and asthma control. This study was conducted to study the effect of balloon sinuplasty in patients affected with rhinosinusitis.

Methods: This prospective study was conducted in all the patients visiting our hospital. Medical treatment included oral and sometimes intravenous antibiotics, nasal steroids, decongestants, systemic steroids, and allergy management. Those who had a positive biopsy were excluded from this study. The selected cohort of 20 patients, were prepared for balloon sinuplasty surgery in the same way as for conventional functional endoscopic sinus surgery (FESS) and were operated by our surgical team.  

Results: 20 patients were included in the study, 70% men and aged 30±12 years. Sinuplasty was performed in 32 sinuses of 20 patients (22 maxillary, 4 sphenoid and 8 frontal sinuses).

Conclusions: Sinuplasty with balloon catheterization is effective in reducing symptoms and improving quality of life in selected patients with chronic rhinosinusitis. The results are beyond reported symptoms and confirm the benefit of balloon sinuplasty.

 
Transoral endoscopic approach versus transcervical with or without mandibular swing approach to parapharyngeal space- a retrospective cohort study in a tertiary care center in Tamil Nadu
Authors: Krishnappa Sheetal , N. Nikisha G.
Published: October 2020

Background: The objective of this study was to evaluate and compare patient outcomes and advantages of endoscopic transoral approach to parapharyngeal space with other approaches like transcervical with or without mandibular swing approach.

Methods: In this retrospective cohort study, we have reviewed 13 cases of parapharyngeal space tumors resected with either trans oral endoscopic assisted approach or external approaches such as trans cervical and mandibular swing approach during the period of June 1, 2015 to May 31, 2020.  

Results: A total of 13 cases were included in the study. Among 13 cases, 9 were operated by transoral endoscopic approach, 2 by transcervical approach and 2 by transcervical with mandibular swing approach. Operative time (p=0.048), blood loss (p=0.028), hospital days (p=0.02) and postoperative patient satisfaction (p=0.008) were more in transoral route compared to transcervical route.

Conclusions: Transoral endoscopic route is a safe route of surgery with less morbidity, less complications, less chance of neurovascular injury and cosmetically more acceptable for the patient when compared to open procedures for smaller size tumors without vascularization, present in the upper part of the parapharyngeal space and without attachment to any neurovascular structures.
Evaluation of hearing acuity in patients with chronic renal failure by pure tone audiometry
Authors: Pathak Netra A. , Nemade Sanjana V. , Shinde Kiran J.
Published: October 2020

Background: Hearing loss is common in patients with chronic renal failure. It is well known that chronic renal failure (CRF) causes different systemic and otorhinolaryngologic manifestations due to the accumulation of nitrogenous waste products. The aim of the study was to evaluate hearing threshold and the severity of hearing loss at different frequencies in patients of chronic renal failure (CRF), and to analyse the role of duration of disease on hearing threshold in patients of CRF.

Methods: Fifty two patients of CRF were included in the study. Pure tone audiometry was done in all cases.

Results: Majority of the patients were in 21 to 40 year age group (mean: out of 52 patients, 38 patients (73.07%) had sensorineural hearing loss and 14 patients (26.93%) had normal hearing. Majority of the patients with hearing loss had mild (44.73%) or moderate (42.11%) sensorineural hearing loss. On comparison of the mean hearing threshold Group II (duration of disease more than five years- 17 patients) showed a statistically significant difference (P<0.05) in mean hearing threshold at 250 Hz.

Conclusions: Hearing loss is present in majority of the patients of CRF. Most of the cases have mild to moderate sensorineural hearing loss. High frequency hearing loss in chronic renal failure is related to the duration of the disease, duration of haemodialysis’ and internal homeostasis, namely hyponatremia.
Comparative study of the outcome of surgical decompression in Ludwig’s angina by conventional skin incision versus multiple interrupted skin incisions
Authors: Rao Kulkarni Manik , P. Navneeth T. , S. Vivek , Rathod Sonu S.
Published: October 2020

Background: Ludwig’s angina is a potentially life threatening infection characterized by a rapidly progressing, bilateral gangrenous cellulitis of all the three primary mandibular spaces namely submental, submandibular and sublingual. If left untreated the cellulitis can progress swiftly to produce obstruction of airway and death. Despite that, no specific guidelines exist and management is greatly dependent on clinical judgement and experience.

Methods: Forty cases of patients with Ludwig’s angina, attending the department of otorhinolaryngology were included in this study and were randomly allocated into conventional incision (CI) and multiple incisions (MI) groups. Following informed written consent, either conventional incision or multiple small incisions were used for drainage and the outcomes analysed.  

Results: The mean age of patients was 28.4 years and majority of the patients belonged to 20-40 years age group. Male to female ratio was 2.3:1.The most common etiology was odontogenic. The outcome of both the conventional group and multiple small incisions group were comparable. The mean hospital stay of the conventional group was 10.25 days and multiple incisions group was 5.31 days which was statistically significant.

Conclusions: Multiple small incisions for the drainage of Ludwig’s angina is a safe and less invasive alternative method, with the advantages being shorter hospital stay and better cosmesis without an increase in complications.
Single centre experience of ossiculoplasty using different materials: a subjective and objective evaluation
Authors: Kumar Vijay , Bhavana Kranti , Bharti Bhartendu
Published: October 2020

Background: Chronic otitis media has serious impact over the ossicular integrity in middle ear resulting in ossicular necrosis and various grades of hearing loss along with other associated symptoms. Tympanomastoidectomy with ossicular reconstruction using various materials can improve the symptoms.

Methods: A retrospective study of 50 patients underwent tympanomastoidectomy with ossiculoplasty in Department of ENT and Head and Neck Surgery at AIIMS Patna from April 2017 to 2018.  Patients with chronic otitis media having ossicular necrosis with ABG (air bone gap) more than 25 dB were included in this study. PORP (partial ossicular reconstruction prosthesis) and TORP (total ossicular reconstruction prosthesis) were used as ossicular reconstruction after clearance of disease. This study was expressed as subjective and objective evaluation following ossiculoplasty.  

Results: Fifty patients having chronic otitis media with decreased hearing and other associating symptoms were included in this study. Preoperative air conduction threshold was 55.32 dB with preoperative ABG was 44.24 dB. Postoperative result was summarised as postoperative AC threshold was 32.72 dB with gain of 22.60 dB with ABG 25.45 dB.

Conclusions: Chronic otitis media may lead to ossicular necrosis and various grade of hearing loss. A proper technique and skilled tympanomastoidectomy with ossiculoplasty can improve the symptoms of chronic otitis media.
Demographics and targeted biopsy with NBI in head and neck mucosal lesions
Authors: Bhandari Pranay , Sachdeva Kavita
Published: October 2020

Background: It is estimated that by the end of year 2020 over 10 million people worldwide would die of cancer every year and about 66% of these would be from developing world like India (WHO-UCC 2003). Our aim in present study was to evaluate the use of targeted biopsy of mucosal lesions of head and neck cancer using narrow band imaging technique, in order to yield more accurate specimen of lesion which will result in correct diagnosis of disease early and to study different demographics of patients.

Methods: Patients lesions were examined under NBI endoscope, best site of biopsy were identified on the basis of increase vascularity, neo-angiogenesis and superficial capillary vessels. Biopsy were taken from this site and sent for histopathological examinations. Considering histopathological report as standard, results from NBI endoscopy were compared to the results of previous studies and conclusion was done. We also studied different demographics of these patients under site of lesion, age distribution, sex distribution, and locality, histopathology type.  

Results: Maximum lesions were found in oral cavity (56.33%). Malignancy was also more common in oral cavity (63.46%), mostly belong to squamous cell carcinoma on histopathology. Mean age of presentation of head and neck mucosal lesion was found to be 48 year and of malignant lesions is 54 years.

Conclusions: We conclude that up to an extent with progression of age malignant lesions increase. Male to female ratio of mucosal lesions is 1.7:1 and of malignancy is 2.25:1. Narrow band imaging endoscopy helps us to identify best site of biopsy, helping in early diagnosis of disease and ultimately reducing morbidity and mortality of patient.
Study of serum adenosine deaminase levels in head and neck malignancies
Authors: M. S. Sudhakar Rao , R. Reshma P.
Published: October 2020

Background: Head and neck malignancies are the malignancies occurring at various sites like scalp, ear, nose and paranasal sinuses, nasopharynx, oral cavity, oropharynx, hypopharynx, larynx, and salivary glands. There are various biomarkers which aid in early diagnosis and management of head and neck malignancies.  In order to study various parameters aiding in early diagnosis, this study has been taken up to estimate serum adenosine deaminase levels among these patients.

Methods: Eighty-eight clinically diagnosed head and neck malignancy patients of both genders were included in this study on simple random basis. After obtaining the written informed consent from the patient, a peripheral venous sample of blood was taken and serum ADA levels were estimated. Data was analyzed using IBM SPSS Version 22.

Results: Serum ADA levels are found to be statistically significant with respect to various stages of head and neck malignancies including malignancy of unknown origin. Mean ADA level in this study was 30.33 IU/l. Mean ADA levels in MUO, primary tumor with neck secondaries were 37 IU/l, 38.7 IU/l respectively. Mean ADA levels in patients with primary tumor without neck secondaries was 27.9 IU/l.

Conclusions: The Serum ADA levels among head and neck malignancy patients including MUO is a simple, inexpensive diagnostic biomarker enzyme which is easy and rapid to estimate. This study emphasizes on using Serum ADA levels as a prognostic indicator among head and neck malignancies who are on various modalities of treatment.
Clinical study of carcinoma of larynx: a retrospective analysis
Authors: K. Mukunda N. , K. Shrivastava R. , M. Vikranth
Published: October 2020

Background: Carcinoma of larynx is the third most common cancer in head and neck, sixth most common cancer among men in India. This study aims to identify the patterns of clinical presentation, epidemiological features and management of laryngeal carcinoma in a tertiary care centre of Indian armed forces.

Methods: This is a retrospective analysis of patients admitted in a Command hospital from January 2007 to December 2009.

Results: A total of 28 patients were treated in 3 year duration. All the patients were males. The majority of patients belonged to 7th decade of life with youngest 49 years old and the oldest 80 years. Supraglottic carcinoma (71%) was the most common laryngeal carcinoma followed by glottic carcinoma(29%).Hoarseness of voice (82%) was the most common presenting complaint followed by dysphagia (42%) and dysponea (21%). 32% of patients reported after initial emergency tracheostomy. 12 (42%) patients were treated with curative surgery, 4 (14%) were treated with curative radiotherapy. Rest of patients required palliative therapy.

Conclusions: Laryngeal carcinoma is found predominantly in males at seventh decade of life and advanced stage. Treatment with curative intent may be possible in around 70% of patients.
Endoscopic trans nasal excision of pterygopalatine fossa schwannoma: case report and review of literature
Authors: Prabha Blessy B. , Rangachari Vijay
Published: October 2020

The pterygopalatine fossa is a difficult area for surgical access and lesions in this area traditionally advocated open external trans maxillary approaches. With endoscopic techniques, it is possible to not only access and explore this area but also plan complete excision of lesions in the pterygopalatine fossa. We present a case report of a 26-year-old lady with complaints of pain in the area of the left cheek for 6 months. She had no other co-morbidities. On clinical examination, no abnormality was detected.  Radiological examination with magnetic resonance imaging showed a lesion possibly a schwannoma in the left pterygopalatine fossa behind the left maxillary sinus. Complete excision was achieved using trans nasal endoscopic technique through the left maxillary sinus. Histopathological examination confirmed the diagnosis of schwannoma.  Post-operative period was uneventful and she was free from any pain and neurological symptoms on subsequent follow up. Schwannomas in the pterygopalatine fossa are rare entities. Endoscopic techniques are safe and effective in accessing the pterygopalatine fossa for excision of lesions situated in this area. This technique obviates the need for external facial incisions or intra oral incisions and helps in good surgical outcomes and quick healing and recovery.   
Sino-orbito-cerebral aspergillosis in an immunocompetent patient: a rare case report
Authors: Phogat Jitender , Nada Manisha , Dahiya Monika , Solanki Sneha
Published: October 2020

Invasive sino-orbito-cerebral aspergillosis is rarely seen in immunocompetent individuals; diagnosis and management of which is still a challenge. We report a case of invasive sino-orbito-cerebral aspergillosis in a 38 year immunocompetent male presenting with mild protrusion of right eye which was associated with no other complaint. His visual acuity was 6/6 in both eyes. There was mild proptosis of right eye of 2 mm on Hertel exophthalmometer with no restriction of the ocular movements. MRI brain, orbit and paranasal sinuses revealed soft tissue swelling in right ethmoid, frontal and sphenoidal air cells and orbit with bony destruction of lamina papyracea with intracranial extension of the mass with destruction of lamina cribrosa. The tissue biopsy was taken from the uncinate process and middle turbinate and sent for histopathological examination which revealed a fibrocollagenous soft tissue which was densely infiltrated by inflammatory cells with presence of large number of foreign body granulomas and filamentous aspergillus fungal hyphae. By radiological and histopathological findings, patient was diagnosed as a case of rhino-orbito-cerebral aspergillosis and given Tb Voriconazole 200 mg BD for 6 months after neurosurgery consultation. His proptosis was revealed at 3 months and repeat MRI showed slightly thickened mucosa of sinuses with no mass lesion seen in the orbit and brain with no evidence of any residual fungal granuloma. Orbital aspergillosis is quite challenging in terms of both diagnosis and treatment. Prolonged antifungal therapy is very effective in controlling infection, if patient is compliant.
Lateral nasal wall haemangioma in a young female: a rare case
Authors: Ansari Ashfaque , Nair Sanjana U.
Published: October 2020

Hemangiomas are benign tumours originating from vascular structures in the body. Histologically they are divided into capillary, cavernous and mixed types. Although it is very commonly seen in head and neck region, it is very rarely seen in the nasal cavity, nasopharynx and paranasal sinuses and it accounts for only 10% of all head and neck haemangiomas. In this patient the haemangioma was seen arising from the lateral nasal wall, of the right nasal cavity. So far in the literature very few such cases have been reported till date.  
Guidelines for rhinology surgery in COVID-19 pandemic
Authors: Juvekar Meenesh , Sarkar Baisali
Published: October 2020

COVID-19 disease was first identified in December 2019 in Wuhan, the capital of China's Hubei province. Amid the ongoing COVID-19 pandemic, India has witnessed a massive surge of coronavirus cases. This study reviews the measures to take by the clinicians involved in rhinology surgery in light of the recent COVID-19 pandemic. The current finding about COVID-19 infection and its relation with severe acute respiratory syndrome coronavirus 2 (SARS-CoV 2) virus is evaluated and possible safety measure guidelines to be taken while doing rhinology procedures is reviewed. The risk of coronavirus 2019 can be largely reduced by wearing personal protective equipment (PPE) kit with powered air purifying respirator, double gloves, eye protection, face shield, gown, shoe covers, limiting attendance to operation theatre, negative pressure room, using negative-pressure otolaryngology viral isolation drape (NOVID) system to cover the patient and proper removal of patient drape after operation. Additionally, low oscillation speeds of microdebrider with continuous suction is associated with low risk of aerosol transmission into the environment. Rhinology and endonasal surgeries are high risk procedures and should adhere to general guidelines set for high-risk procedures. If the proposed protocols are strictly maintained then the risk of getting infected by coronavirus is markedly reduced. In this current scenario is it mandatory to attain the emergent surgical cases with all possible precautions as mentioned and defer the rest of the cases till the pandemic gets over.