Karan Gupta

Tracheal Mucormycosis Pneumonia: A Rare Clinical Presentation

This article reports an unusual case of tracheal mucormycosis following H1N1 pneumonia and reviews previously reported cases. A 40-y-old female with a 5-y history of diabetes mellitus, adequately controlled by oral hypoglycemic agents, developed tracheal mucormycosis after successful treatment for H1N1 pneumonia. The condition was diagnosed during workup for decannulation due to subglottic and upper tracheal obstruction by necrotic chewing gum-like tissue and cartilage. The patient was managed successfully by treatment with amphotericin B and surgical intervention in the form of laryngofissure and Montgomery tube placement. A review of the literature revealed only 5 previously reported cases of tracheal mucormycosis. A high degree of suspicion, early endoscopy and biopsy, histopathological evidence of the infection, and early institution of therapy are the keys to successful outcome.

Endoscopic optic nerve fenestration amongst pediatric idiopathic intracranial hypertension: a new surgical option.

OBJECTIVE To assess the effectiveness of transnasal trans-sphenoid endoscopic optic nerve fenestration for the reversal of vision loss in pediatric idiopathic intracranial hypertension (IIH). MATERIAL AND METHODS This is a single center observational retrospective case series. Fifteen diagnosed pediatric patients of IIH satisfying the modified Dandy criteria and reported to the out-patient services of otolaryngology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India were included in this study. All children underwent thorough clinical examination, complete neuro-ophthalmological work up including visual acuity (V/A), visual field charting(V/F), fundus venogram and radiological work up with MRI for special optic nerve sections in sagittal reconstruction. cerebro-spinal fluid pressure (CSF) measured pre operatively for all children. Standard endoscopic optic nerve sheath fenestration was performed on all children. Visual improvement was assessed by comparing pre-operative ophthalmological findings. RESULTS Improvement in vision was taken as a positive outcome. Vision improved in all except two children, who had pre-existing optic nerve atrophy. CONCLUSION Endoscopic optic nerve fenestration is an effective minimally invasive procedure to revert visual loss in pediatric Idiopathic Intracranial Hypertension.

Endoscopic repair of CSF rhinorrhea: necessity of fibrin glue.

OBJECTIVE The aim of this study is to compare the efficacy of cerebrospinal fluid (CSF) repair with and without fibrin glue in pediatric patients with CSF rhinorrhea treated endoscopically. MATERIALS AND METHODS This was a retrospective study carried out in the Departments of Otolaryngology and Neurosurgery at a tertiary care center between December 2005 and July 2010. RESULTS The 27 patients with CSF rhinorrhea included in the study were divided into Group A: 13 patients who underwent endoscopic endonasal CSF repair using fibrin glue (Tisseel, Baxter, Vienna, Austria) by an endoscopic rhinologist and Group B: 14 patients who underwent endonasal CSF repair without fibrin glue. There was no statistically significant difference in endoscopic CSF repairs with or without fibrin glue (P = 0.48) in all the variables studied. CSF repair without fibrin glue appeared more cost saving as compared to repair with glue. CONCLUSION CSF repairs with and without fibrin glue are equally effective and CSF repair without fibrin is costs saving.

To evaluate disparity between clinical and pathological tumor-node-metastasis staging in oral cavity squamous cell carcinoma patients and its impact on overall survival: An institutional study

Background: Accurate clinical staging is important for patient counseling, treatment planning, prognostication, and rational design of clinical trials. In head and neck squamous cell carcinoma, discrepancy between clinical and pathological staging has been reported. Objective: To evaluate any disparity between clinical and pathological tumor-node-metastasis (TNM) staging in oral cavity squamous cell carcinoma (OCSCC) patients and any impact of the same on survival. Materials and Methods: Retrospective chart review from year 2007 to 2013, at a tertiary care center. Statistical Analysis: All survival analyses were performed using SPSS for Windows version 15 (Chicago, IL, USA). Disease-free survival curves were generated using Kaplan-Meier algorithm. Results: One hundred and twenty-seven patients with OCSCC were analyzed. Seventy-nine (62.2%) were males and 48 (37.8%) females with a mean age at presentation 43.6 years (29-79 years). The highest congruence between clinical and pathological T-staging seen for clinical stage T1 and T4 at 76.9% and 73.4% with pathological T-stage. Similarly, the highest congruence between clinical and pathological N-stage seen for clinical N0 and N3 at 86.4% and 91.7% with pathological N-stage. Of clinically early stage patients, 67.5% remained early stage, and 32.5% were upstaged to advanced stage following pathological analysis. Of the clinically advanced stage patients, 75% remained advanced, and 25% were pathologically downstaged. This staging discrepancy did not significantly alter the survival. Conclusion: Some disparity exists in clinical and pathological TNM staging of OCSCC, which could affect treatment planning and survival of patients. Hence, more unified and even system of staging for the disease is required for proper decision-making.

Hypothyroidism after hemithyroidectomy for colloid goiter: Is it a reality

Objective: The objective was to determine the overall risk of hypothyroidism (clinical and subclinical) after hemithyroidectomy for colloid goiter. Materials and Methods: Prospective review of 54 patients who underwent hemithyroidectomy for colloid goiter at a tertiary care center from January, 2010 to December, 2012 with regular follow-up. Results: A total of 54 patients were included in the study with 38 females and 16 males (M:F = 1:3). Mean age was 38 years (range: 23-59 years). All underwent hemithyroidectomy for preoperative diagnosis of colloid goiter, which was confirmed on postoperative histopathological examination. Patients were kept on regular follow-up with repeat thyroid function tests after every 6 months. Mean follow-up was 30.7 months. Subclinical hypothyroidism was found in 8 patients (14.8% prevalence) at a mean follow-up of 16.7 months postsurgery. T3 and T4 levels were within normal limits in all patients with no clinical hypothyroidism detected. No patient was on thyroid hormone supplementation. Conclusion: Our study shows a 14.8% prevalence of subclinical hypothyroidism following hemithyroidectomy for colloid goiter. Patients with subclinical hypothyroidism are at an increased risk of developing clinical hypothyroidism. The risk of hypothyroidism after hemithyroidectomy is an important element in decision making for individual patient and health care provider.