Savita Lasrado

Role of concomitant chemoradiation in locally advanced head and neck cancers.

Standard therapy for advanced head and neck cancer consists of a combination of surgery and radiation. However, survival of this patient population has not improved during the past 20 years. Many different multimodality treatment schedules have been proposed, and chemotherapy is often used with the intent of organ preservation. The present study was intended to establish the efficacy of concomitant chemoradiation with a single agent carboplatin in advanced head and neck cancers.The objectives were to investigate the feasibility of concomitant administration of carboplatin, monitor acute toxicity during radiotherapy, and determine subacute side effects, such as wound healing following surgery after chemoradiotherapy. A prospective study was conducted wherein a total of 40 patients with stage III and IV squamous cell carcinomas of oral cavity, oropharynx, hypopharynx and larynx were enrolled. All patients were treated with external beam radiotherapy and weekly carboplatin area under curve (AUC of 5). Radiotherapy was given in single daily fractions of 1.8-2 grays (Gy) to a total dose of 66-72 Gy. Salvage surgery was performed for any residual or recurrent locoregional disease. Neck dissection was recommended for all patients with neck disease showing less than a complete response after chemoradiation. A total of 40 patients were enrolled of whom 32 were males and 8 were females. Highest incidence of cancer was seen in the 5th-6th decades of life with a median age of 47.7 years. Oropharyngeal tumours constituted a maximum of 21 patients followed by hypopharynx in 10, larynx in 7 and oral cavity in 2. 80% of the patients had a neck node on presentation of which 40% had N2-N3 nodal status. TNM staging revealed that 58% of patients were in stage III and 43% in stage IV. Evaluation of acute toxicity revealed that 50% had grade II mucositis, 25% grade III mucositis, 2.5% grade IV mucositis. 50% of patients had grade I skin reactions, 65% of patients had grade I thrombocytopenia, and 24% of patients had grade I anaemia. After completion of treatment 65% of patients had complete response at the primary and regional sites, and 35% of patients had a partial response of whom 23% underwent neck dissection and 5% of them underwent salvage surgery at the primary site. At the end of one year there were six deaths and four recurrences and 70% were free of disease. Concurrent chemoradiation with carboplatin provided good locoregional control for locally advanced head and neck cancers. This regimen, although toxic, is tolerable with appropriate supportive intervention. Primary site conservation is possible in many patients. Chemoradiotherapy appears to have an emerging role in the primary management of head and neck cancers.

Clinicopathological Profile of Head and Neck Cancers in the Western Development Region, Nepal: A 4-Year Snapshot

Regional cancer epidemiology is an important basis for determining the priorities for cancer control in different countries worldwide. There is no reliable information about the pattern of head and neck cancer in western Nepal and hence an attempt was here made to evaluate the situation based on hospital data, which provide the only source in the western region of Nepal. A clinicopathological analysis of head and neck cancers treated between 2003 and 2006 in Manipal Teaching Hospital affiliated to Manipal College of Medical Sciences, Pokhara, Western Development Region, Nepal was performed. A total of 105 head and neck cancer cases were identified with a male to female ratio of 1.8:1. The median ages of male and female patients were 62 and 64 years, respectively. Ninety-seven (92.4%) of the cancer patients were suffering from carcinoma, three (2.9%) had blastoma, three (2.9%) had sarcoma, and two (1.9%) had lymphoma. The majority (61.9%) of carcinoma cases were squamous cell carcinoma followed by anaplastic carcinoma (7.2%). Of the carcinoma cases, the most common site of primary lesion was larynx (19.6%), followed by the thyroid (14.4%), the tongue and hypopharynx with 10.3% cases each. Comparative analysis among males and females did not reveal any sex difference in type of head and neck cancers. The head and neck cancer pattern revealed by the present study provides valuable leads to cancer epidemiology in western Nepal and useful information for health planning and cancer control, and future research in western Nepal.

Bilateral calcified stylohyoid ligament: an incidental autopsy finding with medicolegal significance.

Eagles syndrome occurs due to elongation of the styloid process or calcification of the stylohyoid ligament, which then may produce a pain sensation due to pressure exerted on various structures in the head and neck region. A case report of calcified stylohyoid ligament found incidentally at autopsy and further confirmed by computed tomography scan and histopathology is herein discussed with associated medicolegal significance.

Isolated Horner's syndrome following penetrating neck injury.

Department of Emergency & Critical Care Medicine, Sri Gokulam Hospital & Research Institute, Salem India Department of Forensic Medicine & Toxicology, Srinivas Institute of Medical Sciences & Research Centre, Mangalore, India Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA Department of Internal Medicine, Chennai Medical College Hospital & Research Center, Irungalur, Trichy, India Department of Otorhinolaryngology – Head & Neck Surgery, Father Muller Medical College, Mangalore, India

Breaking your heart—A review on CPR-related injuries

&NA; Cardiopulmonary resuscitation (CPR) has been shown to increase survival after cardiac arrest, but is associated with the risk of acquired injuries to the patient. While traumatic chest wall injuries are most common, other injuries include upper airway, pulmonary and intra‐abdominal injuries. This review discusses the risk factors and prevalence of CPR‐related injuries. Highlights:CPR, although lifesaving, may be associated with significant injuries.CPR is associated with a wide range of injuries, from the head and neck down to the abdomen and pelvis.Appropriate technique and position of chest compression may help prevent some CPR‐related injuries.CPR‐related injuries should be considered in all patients who do not improve despite correction of the cause of arrest

Postaural incision closure in single layer versus multiple layers: A comparison

Background: By tradition, the postaural incision is closed in single or multiple layers. In this study single layer closure is compared with multiple layer closure. Materials and Methods: Two hundred patients with Chronic suppurative otitis media undergoing ear surgery by post aural approach at our department were included in the study. Results: It was observed that time taken for single layer closure was far less compared with time taken for multiple layer closure, which was of statistical significance. Conclusion: single layer closure is as effective as multiple layer closure of postaural incision, with the distinct advantages of reduced closure time and lesser cost of suture material.

A Rare Case of Adenoid Cystic Carcinoma of the Sphenoid Sinus Presenting with Lateral Rectus Palsy

A rare case of adenoid cystic carcinoma arising from the sphenoid sinus causing lateral rectus palsy is presented here. Adenoid cystic carcinoma of the paranasal sinuses is an aggressive neoplasm which needs early diagnosis and treatment. Ideal treatment paradigm for paranasal sinus tumors is yet to be established. A combination of surgery and radiotherapy offers a better disease control and survival.

Severe esophageal damage caused by button battery ingestion in a 10-month-old infant

Foreign body ingestion is commonly encountered in infants and young children. Button batteries represent a special category of pediatric ingested foreign bodies because of the serious possibility of complications when impacted in the esophagus. Herein we report a case of emergency medicine in a 10-month-old infant who accidentally ingested a button battery, causing severe esophageal damage. He presented with excessive crying and decreased oral intake. A chest radiograph revealed a coin shadow at the mid-esophagus, which subsequently led to the diagnosis and removal of the object. Postoperative treatment options such as antireflux therapy, antibiotic therapy, steroids, and esophageal stenting, which are still controversial, have been discussed in this paper. With increasing accessibility to electronic toys and gadgets, accidental ingestion is on the rise in infants and young children. Judicious management should be tailored in every case.