Nitish Baisakhiya

Unusual Sites of Epidermoid Cyst

Epidermoid cyst is usually due to infection of pilosebaceous gland or due to traumatic migration of epidermis to the deeper structure of skin. They may present in any place of body which is lined by squamous epithelium. They are rarely present in head neck and in oral cavity. We are presenting rare cases of epidermoid cyst presenting in post aural region and floor of mouth.

Characteristics of patients who died from traumatic brain injury in two rural hospital emergency departments in Maharashtra, India, 2007-2009.

Introduction: Trauma is one of the leading causes of morbidity and mortality in the world and in India. Objective: To describe 1) selected epidemiological and clinical characteristics of persons with traumatic brain injury (TBI) who died within 24 h after admission to the emergency departments (EDs) of two medical facilities in rural India and 2) the methods used to transport these patients from the locale of the injury incident to the study sites. Materials and Methods: Medical records of all injured patients regardless of age or sex who died within 24 h after admission to both EDs during January 31, 2007 through December 31, 2009 were reviewed and abstracted. Demographic variables and information on prehospital care, time and mechanism of injury, mode of transport to EDs, and primary hospital resuscitation were abstracted and analyzed. Results: Of the 113 injured patients in this study, 42 had TBI and died within 24 h of ED admission. All of these TBI patients were transported to the ED by relatives or bystanders in non-ambulance vehicles. Most of the patients with TBI (78.5%) were 21-50-years-old; and overall 90.0% were males. Persons working near or along busy roads struck by vehicles accounted for 80.9% of all TBI cases. Severe TBIs were present in 97.6% of the patients; of these, 92.8% had a Glasgow Coma Scale (GCS) score of 3 on arrival. Other concurrent injuries included superficial lacerations (85.7%), facial injuries (57.1%), and upper (35.7%) and lower (30.9%) extremity fractures. Common lesions recognized on computed tomography (CT) scan were acute subdural hematoma (21.4%), subarachnoid hemorrhage with diffuse cerebral edema (16.6%), and skull base fracture with diffuse cerebral edema (14.2%); in 21.4% of cases, the CT scan were reported normal. Conclusion: Most of the TBI patients who died within 24 h after admission to EDs in this study were not transported to EDs in emergency medical vehicles; most were of working age (ages 20-50 years); were male; and were day laborers working on busy interstate roads where they were hit by vehicles.

A comparative study of ceruminolytic agents

A prospective study was done to access the efficacy of ceruminolytic agents, i.e 2% paradichlorobenzene, 10% sodium bicarbonate, 2.5% acetic acid and normal saline. All score 4 hard impacted ear wax cases in the adult population (>20 years) were accrued for the assessment of the relative efficacy. Upon analyzing the comparative efficacy of four ceruminolytic agents, by taking into consideration three parameters (post) ceruminolytic cerumen score, attempts of syringing required to extrude the cerumen mass, post-ceruminolytic use and appearance of the removed cerumen mass. 2% paradichlorobenzene emerged as the most superior ceruminolytic, closely followed by 10% sodium bicarbonate. 2.5% acetic acid fared moderately while normal saline emerged as the least efficacious ceruminolytic agent.

Study the Role of Nasal Scrap Cytology in Allergic Rhinitis Patients in Rural Population

Allergic Rhinitis is one of the gift of modern era. Condition is involving wide range of age group starting from children to old age people. In spite of latest diagnostic facility and advanced treatment, it is still a great challenge for the otorhinolaryngologist. This study was done to perform simple and cost effective test to understand the severity of Allergic Rhinitis. To investigate the patients of allergic rhinitis with specific focus on nasal scrape cytology. After applying inclusion and exclusion criterion were found suitable and hence selected for the present study. 100 patients who were clinically diagnosed on history and examination as allergic rhinitis were included as cases while control group consisted of 100 subjects having no symptoms of allergic rhinitis. These patients were a subjected to nasal scrape cytology for which Cytobrush Plus (Medscand Cell Sampling Kit), Malmo, Sweden, was employed. Mucosal specimens were acquired by scraping the surfaces of the middle thirds of inferior turbinates with Cytobrush Plus (Medscand Cell Sampling Kit), Malmo, Sweden. The samples thus obtained were transferred onto glass slides to be fixed in 95% ethyl alcohol and stained with May Gurwald Gimesa stain to study pattern and profile of different types of cells like eosinophils, goblet cells, mast cells. The nasal eosinophils were studied under 1000 × magnification of light microscope 10-well spread, high power epithelium fields were examined and the quantitative score of nasal eosinophils was rated according to a scale described by Meltzer. In study group all 100 patients underwent nasal scrape cytology. 25 (25%) patients in study group showed grade 1 + nasal eosinophilia followed by grade ½ + in 24 (24%), grade 0 in 22 (22%) and grade 2 + in 21 (21%). In control group 80% of subjects had grade 0 nasal eosinophilia. Difference between nasal eosinophilia in the study and the control group were found to be statistically significant. In study group 54% showed grading > 0.5 + whereas 46% showed ≤ 0.5 + . The sensitivity and specificity were observed to be 54% and 100% respectively. The results thus found were statistically significant. Nasal scrape cytology which was an added dimension proved to be a more specific than sensitive test. The specificity of nasal scrape cytology in our study was 100%. Sensitivity was only 54%. 22% of the patients of allergic rhinitis showed an eosinophil count more than 300/cu mm.

Large cerebello-pontine epidermoid tumor in a child

Abstract Cerebellopontine angle lesions are more commonly found in adults; however, they are uncommon in children. 13 year female child presented with progressive cerebellar signs and decreased hearing in left ear. Magnetic resonance imaging was suggestive of left cerebello-pontine angle epidermoid tumor that was treated surgically. In this rare case we discuss the imaging findings and review the relevant literature.

Fulminant cranio-cerebral invasive aspergillosis in a patient with phytophotodermatitis

Cranio-cerebral invasive aspergillosis of sino-nasal involving the skull base is rare and associated with a very high mortality due to its peculiarly fulminant clinical course. We present an unusual case of 55-year-old diabetic female who initially treated for phytophotodermatitis, but later on she developed massive invasive cerebral aspergillosis. Advances in diagnosis and management of aspergillosis with improved and early detection and more effective therapy have promised some success in the management of these devastating infections.

Giant schwannoma arising from cervical nerve root with intra-thoracic extension

Schwannomas are well-encapsulated benign neurogenic tumors that arise from the nerve sheaths of peripheral nerves. Schwannomas may occur nearly anywhere in the body, but have a predilection for the head and the neck, with an incidence of 40-50%. Rarely, the cervical nerve root can be the site of a large dumbbell neurogenic tumor in the neck. In the present article, we describe the case of a 40-year-old male with a large schwannoma arising from the cervical nerve root with intrathoracic extension. Surgical excision is the treatment of choice for neurogenic tumors, and it has been described that if the lesion is known to be a schwannoma, it is possible to open the capsule and shell out the tumor from the nerve, possibly avoiding functional deficits. However, as in the present case, it may not be possible to resect the tumor safely from the involved nerve root and it may be necessary to sacrifice the nerve involved in the tumor to achieve complete resection.