Gopalakrishnan Surianarayanan

Pott's puffy tumor in pediatric age group: A retrospective study

OBJECTIVE To study the etiology, clinical features and treatment outcomes of pediatric Potts puffy tumor (PPT). METHODS This retrospective study was carried by reviewing medical case record of pediatrics PPT cases admitted to our hospital from January 2010 to august 2011. Data regarding the patients demographic details, presenting symptoms and signs, etiology, laboratory findings, imaging findings, management, complications and outcomes of treatment were collected and analyzed. RESULTS A total of five cases of PPT were found. Three were male and two were female with a mean age of 11.6 years. All patients presented with headache, fever and tender forehead swelling. Nasal polyps and discharging sinuses over forehead were present in one case and one case had preseptal orbital cellulites in addition to PPT. None of the patient had intracranial complications. Three cases (60%) were secondary to acute frontal sinusitis, one case was as complication of chronic sinusitis and one case was because of trauma. Contrast enhanced Computerized tomography (CECT) demonstrated features of acute sinusitis in 3 cases, sinonasal polyp in one, fracture of anterior table of frontal bone in one case, subperiosteal collection and erosion of anterior table frontal bone in all cases. All patients required surgical intervention; Endoscopic approach 2 cases (40%), combined approach in 2 cases (40%) and external approach in one case (20%) in addition to aggressive antibiotic treatment. There was purulent discharge in frontal sinuses in all cases. In 2 cases (40%), culture of pus drained during surgery was positive; one case methicillin resistant Staphylococcus aureus sensitive to vancomycin, other Pseudomonas aeruginosa sensitive to ceftazidime and amikacin. All cases improved with treatment. There were no postoperative complications or facial cosmetic deformity except facial scar in three cases. The average hospital stay was two weeks and ranged from 10 days to 21 days. All patients received antibiotics for 6-8 weeks to treat osteomyelitis of the frontal bone. The average length of follow up was 9 months (range 6-18 months). All patient are doing well and are under regular follow up. CONCLUSIONS PPT is a complicated infection of frontal sinusitis and trauma that requires broad spectrum antibiotics and surgical treatment. Diagnosis is made by high clinical suspicion of this condition and confirmed by CECT. Early treatment results in favorable outcomes and decreases the risk of further complications.

CYP1A1 polymorphisms and the risk of upper aerodigestive tract cancers in an Indian population.

The inter‐individual differences in upper aerodigestive tract (UADT) cancer risk may be partly attributed to the polymorphic variability in the CYP1A1 gene that is involved in the metabolic activation of xenobiotics to carcinogenic reactive metabolites.

Gene–environment interactions associated with CYP1A1 MspI and GST polymorphisms and the risk of upper aerodigestive tract cancers in an Indian population

PurposeGenetic risk to tobacco related cancers are associated with polymorphisms in CYP1A1 and GST, which are involved in the metabolic activation and detoxification of carcinogens. The genetic variations in these drug-metabolizing enzymes may alter the susceptibility to UADT cancers triggered by environmental exposures. The hospital-based case–control study evaluated the impact of combined CYP1A1 MspI and GST (M1 & T1) polymorphisms among the individuals exposed to environmental risk factors as modulators in the risk of UADT cancers in Tamilians, a population of south India.MethodsThe unrelated histopathologically confirmed 408 cases and 220 population-based controls matched by age and gender were genotyped for CYP1A1 MspI, GSTM1 and GSTT1 polymorphisms using PCR based methods. To investigate the potential gene–environment interactions, analyses were carried out stratifying by smoking and tobacco chewing status using SPSS software.ResultsThe combination of genes and environment interactions by stratified analyses revealed significant interactions among the habitual tobacco smokers (CYP1A1 MspI & GSTM1 null: OR 14.06; 95% CI 3.90–50.68, CYP1A1 MspI & GSTT1 null: OR 33.28; 95% CI 4.24–261.19) and tobacco chewers (CYP1A1 MspI & GSTM1 null: OR 20.51; 95% CI 6.77–62.13, CYP1A1 MspI & GSTT1 null: OR 79.35; 95% CI 10.40–605.55) on the multiplicative scale.ConclusionOur findings have indicated that the individuals polymorphic for CYP1A1 MspI either with GSTM1 null or with GSTT1 null genotypes revealed an increased risk for UADT cancers than that ascribed to a single susceptible gene among the tobacco users in the population [single gene risk among smokers and chewers, respectively, for CYP1A1 MspI (OR 6.43; 95% CI 3.69–11.21); (OR 10.24; 95% CI 5.95–17.60), GSTM1*0 (OR 3.77; 95% CI 1.94–7.37); (OR 7.97 95% CI 4.10–15.76) and GSTT1*0 (OR 6.95 95% CI 2.88–16.77); (OR 25.83 95% CI 7.78–85.76).

The efficacy of radiofrequency volumetric tissue reduction of hypertrophied inferior turbinate in allergic rhinitis.

OBJECTIVES To evaluate the efficacy of radiofrequency volumetric tissue reduction (RFVTR) technique in treatment of allergic inferior turbinate hypertrophy (ITH) and to study its effect on nasal mucociliary clearance. MATERIALS AND METHODS This prospective study was conducted over 50 perenial allergic rhinitis patients with persistent nasal obstruction due to bilateral ITH refractory to medical management received one time RFVTR of both inferior turbinates. Symptoms were subjectively assessed by Visual Analog Scale (VAS) and mucociliary clearance was measured by saccharin transit time (STT) pre-operatively, at 1 week, 1, 3, and 6 months post-operatively. RESULTS Forty-seven subjects completed study. All patients had significant symptomatic improvement which started from 1 week post-operatively and persisted up to 3 months. Post-operative VAS scores of nasal obstruction, rhinorrhea, sneezing, headache, and snoring at 1 week 1, 3 and 6 month follow up visits significantly decreased (P < 0.05) whereas significant decreased in post-operative VAS scores of hyposmia was observed at 1 month follow up (P < 0.05). Though increase in VAS scores was observed during 6 month follow up, the difference between pre-operative and 6 month post-operative mean VAS score was statistically significant (P < 0.05). Symptomatic improvement in nasal obstruction, rhinorrhea, sneezing, headache, hyposmia, and snoring persisted in 89.4%, 95.6%, 97.8%, 88.5%, 46.7%, and 100% of patients, respectively, during 6 month follow up. There was no significant change in STT following RFVTR except at 1 week follow up (P < 0.0001). CONCLUSION RFVTR is safe and effective in treatment of ITH in allergic rhinitis patients.

ABCB1 genetic polymorphism and risk of upper aerodigestive tract cancers among smokers, tobacco chewers and alcoholics in an Indian population.

Background and objective Upper aerodigestive tract (UADT) cancers are associated with the tobacco use and alcohol consumption. Certain toxins and carcinogens causing UADT cancers are found to be substrates of polymorphic ABCB1 gene encoded P-glycoprotein efflux pump. This study investigates the association between ABCB1 gene polymorphism at exon 26 (3435C>T) and risk to UADT cancers in Tamilians, a population of south India. Methods The study included 219 unrelated histopathologically confirmed cases and 210 population-based controls. Genomic DNA was extracted from peripheral leukocytes and genotyped for ABCB1 3435C>T polymorphism by PCR-restriction fragment length polymorphism method. Results The multivariate logistic regression analyses demonstrated that the homozygous ABCB1 TT genotype was significantly associated with an overall increased risk for developing UADT cancers [odds ratio (OR): 2.53; 95% confidence interval (CI): 1.28–5.02]. Further, the determination of gene–environment interaction by stratified analyses have revealed a significant interaction between the smoking and homozygous TT genotype [(OR: 7.52; CI: 1.50–37.70) and (OR: 16.89; CI: 3.87–73.79) for 11–20 and >20 pack-years, respectively]. The strongest interaction was observed among the regular tobacco chewers (OR: 45.29; CI: 8.94–130.56) homozygous for TT genotype. No suggestion, however, of an interaction between the genotypes and the alcohol consumption on the multiplicative scale was made. Conclusion The ABCB1 gene polymorphism at exon 26 (3435C>T) may be one of the risk factors for susceptibility to UADT cancers. Furthermore, the significant interaction among habitual smokers and tobacco chewers, homozygous for TT genotype modulates the risk to UADT cancers in the Tamilian population of south India.

Gene-gene interactions of drug metabolizing enzymes and transporter protein in the risk of upper aerodigestive tract cancers among Indians

BACKGROUND The combined genetic effects of single nucleotide polymorphisms may additively or synergistically contribute to the increased cancer risk. The interactions associated with xenobiotic metabolizing enzymes and transporter protein involved in the biotransformation and transport of xenobiotics could determine the functional outcomes over the independent effects of a single susceptibility gene in the risk of upper aerodigestive tract cancers. METHODS The hospital-based case-control study evaluated CYP1A1 (*2A and *2C), CYP2E1 (*1B, *5B, and *6), GST (M1, T1, and P1) and ABCB1 3435C>T polymorphisms among 408 histopathologically confirmed cases and 220 controls using polymerase chain reaction based methods in an Indian population. RESULTS The multivariate logistic regression analyses demonstrated potentially high risk gene-gene interactions with the concurrent deletions of the GSTT1 and GSTM1 genes and GSTP1 variant genotypes (OR 5.81; 95% CI 1.01-40.28), the deletions of GSTT1 and GSTM1 genotypes with variant genotypes of CYP1A1*2A (OR 8.21; 95% CI 1.91-49.48), GSTT1 and GSTM1 deficient genotypes along with CYP2E1*1B variant genotypes (OR 6.73; 95% CI 1.32-22.81), the polymorphic genotypes of ABCB1 and deficient GSTT1 (OR 6.08; 95% CI 2.21-16.76) and an enhanced risk with the combined variant genotypes of CYP1A1*2A, GSTT1 and ABCB1 (OR 11.14; 95% CI 2.70-46.02). CONCLUSION The findings indicate that the interactions associated with various drug metabolizing enzymes and transporter protein exhibit high risk for UADT cancers than that ascribed to a single susceptible gene. This was particularly established among the polymorphic carriers of CYP1A1*2A, GSTT1 and ABCB1 genes in the population investigated.

Accidental entry of fish into throat while bathing in a pond.

While fish bones are common foreign bodies in the throat, a whole live fish in the pharynx is very rare. We report a case where a whole fish accidentally entered the throat of a 52-year-old male, where it became lodged causing throat pain and dysphagia. The fish was removed as an emergency procedure.

First Branchial Cleft Malformation with Duplication of External Auditory Canal

First branchial cleft anomalies are uncommon, accounting for less than 10% of all branchial abnormalities. Their rare occurrence and varied presentation have frequently led to misdiagnosis and inadequate and inappropriate treatment of these conditions leading to repeated recurrences and secondary infection. In this paper, a case of 11-year girl with type 2 first branchial cleft defect is described. She first presented with a nonhealing ulcer of upper neck from childhood. Diagnosis had previously been missed and treated as tubercular ulcer. We confirmed the correct diagnosis by history and computerized tomography fistulogram. The lesion was completely excised with no further recurrence.