The cervical lymphadenopathy due to metastasis carry poor prognosis. The status of cervical nodes is of critical interest to surgical, radiation and medical oncologists who manage patients with head and neck cancers. We conducted a prospective randomized study to assess the role of palpation, ultrasound and CT in detection of cervical metastasis in 25 patients presented to us with head and neck malignancy irrespective of cervical nodal status. It was observed that clinical examination was least sensitive (73.33%) when compared with computerized tomography (80%) and ultrasound (93.93%). The computerized tomography was found to be most specific (90%) when compared to clinical examination or ultrasonography (70% each).
Palpation; Ultrasonography; Computerized Tomography; Cervical lymph node; Metastasis
Objectives; To determine the effect of neonatal hyperbilirubinemia on auditory brainstem responses (ABRs) and evaluate ABR responses to lowering of bilirubin levels.Study Design: prospective case control trialSetting: tertiary referral center.Patients: 60 neonates (40 cases & 20 controls). Term appropriate for date(AFD) neonates with uncomplicated birth history and bilirubin level of ≥ 13 mg/dL were included as cases, those with bilirubin value of < 13 mg/dL were taken as controls.Interventions; First BERA examination was carried out within 24 hrs of the diagnosis of hyperbilirubinemia and repeat examination was done when total serum bilirubin came down to < 13 mg/dL with treatment. Comparisons were made between cases (before & after therapy) and controlResults; No abnormality in neonates with bilirubin < 18 mg/dL. Abnormal ABRs were observed in 24(60%) of the 40 cases studied, with therapy it reverted back to normal in 15(62%). The commonest abnormality noted was prolonged latency of wave V(42.5%), followed by prolonged latency of wave III(35%) and wave I(22.5%). Prolonged latency of wave I was found in only those with bilirubin > 20mg/dL. Inter peak latency of wave IV (Brain stem conduction time) was prolonged in 8 cases; it reverted to normal in all cases. Prolonged inter peak latency of wave I–III was observed in 7 cases, of which it reverted to normal in 6. Absent waves reappeared in 4 out of 5 cases, but abnormal amplitude ratios reverted to normal in only one of the 7 cases in which it was abnormal.Conclusions; about 60% of term A FD neonates with serum bilirubin of > 18mg/dL will demonstrate ABR changes. Most of these changes revert to normal early after therapy, indicating need for aggressive therapy in this subgroup of neonates.
Auditory brainstem responses; hyperbilirubinemia; kernicterus
Previous studies demonstrated that an outer membrane c-type cytochrome, OmcB, was involved in Fe(III) reduction in Geobacter sulfurreducens. An OmcB-deficient mutant was greatly impaired in its ability to reduce both soluble and insoluble Fe(III). Reintroducing omcB restored the capacity for Fe(III) reduction at a level proportional to the level of OmcB production. Here, we report that the OmcB-deficient mutant gradually adapted to grow on soluble Fe(III) but not insoluble Fe(III). The adapted OmcB-deficient mutant reduced soluble Fe(III) at a rate comparable to that of the wild type, but the cell yield of the mutant was only ca. 60% of that of the wild type under steady-state culturing conditions. Analysis of proteins and transcript levels demonstrated that expression of several membrane-associated cytochromes was higher in the adapted mutant than in the wild type. Further comparison of transcript levels during steady-state growth on Fe(III) citrate with a whole-genome DNA microarray revealed a significant shift in gene expression in an apparent attempt to adapt metabolism to the impaired electron transport to Fe(III). These results demonstrate that, although there are many other membrane-bound c-type cytochromes in G. sulfurreducens, increased expression of these cytochromes cannot completely compensate for the loss of OmcB. The concept that outer membrane cytochromes are promiscuous reductases that are interchangeable in function appears to be incorrect. Furthermore, the results indicate that there may be different mechanisms for electron transfer to soluble Fe(III) and insoluble Fe(III) oxides in G. sulfurreducens, which emphasizes the importance of studying electron transport to the environmentally relevant Fe(III) oxides.
Secondary tuberculosis of pharynx is quite a rare condition as pharynx is not a common site for clinically manifest tuberculosis. This study reports a rare and unusual case of secondary oropharyngeal tuberculosis in a 40 years mole patient, who presented with an ulceroprotiferative lesion of Oropharynx extending to nasopharynx and laryngopharynx which besides being tender, bled on touch. There was no associated cervical lymphadenopathy. Routine laboratory investigations were within normal range except raised ESR. Chest x- ray revealed bilateral apical lesions. The patient vas put on antitubercular therapy, with which the patient improved.
Foreign body in the trachea is not uncommon but foreign body of autogeneous origin is rare with stray dog bite.
Autogenous, Foreign Body, Stridor
Melkersson - Rosenthal syndrome was described by Melkersson and Rosenthal separately in the year 1928 and 1931 respectively. It is supposed to be a rare syndrome of bilateral alternating recurrent facial paralysis alongwith fissured tongue and oedema of the lips, face and eyelids. A case of Melkersson - Rosenthal syndrome is reported with all the classic findings which is a rarity. In this case there was alternating facial paralysis to begin with followed by bilateral paralysis third time, along with oedema of lips and face, fissured tongue, and dialation of sig-moid colon with absence of haustrations.
Tubercular parotitis is an extremely rare clinical condition which is difficult to diagnose. The rarity of this condition can be seen from the evidence of only a few reported cases in the litera-ture. Tubercular infection is quiet common in this part of the world, but Tubercular Parotitis is still a rarity. A case of Bilateral tubercular parotitis diagnosed by FNAC, showing tubercular involvement of the intra parotid lymph node is presented due to its rarity.
Audiovestibular functions in 50 cases of diabetes mellitus have been evaluated to find out the type of hearing loss. Diabetes mellitus causes a significant bilateral symmetrical hearing loss at higher frequencies and with the progress of disease and added complications the hearing further deteriorates. On control of diabetes hearing changes are found to be irreversible. However vestibular functions remain uninvolved in cases of diabetes mellitus. A direct correlation was found between hearing loss and increasing blood sugar level.
Twenty one (16.5%) cases of Occult primary 10 males and 3 females were analysed out of 121 cases of secondaries in the neck regarding their diagnosis and non surgical management over a period of six years, from march 1990 to Feb., 1996 in the department of ENT and Radiotherapy of I.G.M.C. & Hospital, Shimla. Majority of these cases were in the age group of 50-70 years and 95% of these cases had squamous cell carcinoma & in one case there was adenocarcinoma. 12 (57%) of these patients were in N3stage. 13 patients were treated by radiotherapy, 3 by chemotherapy whereas remaining 5 cases absconded and therefore no treatment could be given to them.
Twenty one (16.5%) cases of Occult primary (18 males and 3 females) were analysed out of 121 cases of secondaries in the neck regarding their diagnosis and non-surgical management over a period of six years, from March, 1990 to Feb., 1996 in the department of ENT and Radiotherapy of I.G.M.C. and Hospital Shimla. Majority of these cases were in the age group of 50-70 years and 95% of these cases had squamous cell carcinoma and in one case there was adenocarcinoma. 12 (57%) of these patients were in N3 stage. 13 patients were treated by radiotherapy, 3 by chemotherapy whereas remaining 5 cases absconded and therefore no treatment could be given to them.
The results of auditory brainstem evoked responses in 25 subjects of presbyacusis are compared with 25 age and sex matched controls. Absolute latent periods of wave I through V were significantly prolonged in presbyacusis group. Delayed wave I and no significant change in interwave interval latencies of I-V, III-V and mild shortening of interwave interval of I-III in presbyacusis is observed.
Presbyacusis; Sensori-Neural Deafness; Latency
Cost consideration has special relevance in psychiatric practice, where the drug treatment has to be continued for long duration. On evaluating, the cost of different brand names, of the same generic drug using CIMS and MIMS (India, 1991), it was found that Cost Range and Cost Ratio varies considerably. The Cost Ratio is more than 3 for Tab. Thioridazone 100 mg and Cap. Daxepin 75 mg. Since, the superiority of any costlier brand over the others has never been reported, and keeping in view the financial aspect of prescribing the cheapest of the brand available should be prescribed, whenever possible.