Novel Scoring Formula to Predict Survival in Patients of Primary Tongue Cancer Belonging to Tobacco Chewing Population.

Worldwide and in India head and neck malignancies are a major contributor to cancer mortality and morbidity. Tongue cancer predominates oral cavity cancers worldwide but in India it comes next to buccal mucosa. OPD patients after completing treatment tend to ask about the prognosis of their disease where they want an objective answer to "How long will I live?" His scoring system is intended to answer this question and guide patients for adjuvant therapy. This study enrolled all patients between 20 and 85 years old with a history of tobacco chewing at least for the last 1 year before diagnosis. Patients should have primary tongue cancer amenable to surgical resection. For survival calculation, date of diagnosis was taken as reference time. Using Kaplan-Meier survival analysis, clinicopathological factors significantly associated with survival were ascertained. Then using logit regression, a scoring system predicting patient survival in years based on clinicopathological risk factors was formulated and internal validation was done. A total 241 were enrolled and there were 69 cancer-related deaths. T stage, N stage, LVSI, and DOI were found to be significantly associated with cancer-related survival in tongue cancer patients. Another factor affecting survival was defaulting adjuvant radiation therapy. Using these variables, a survival predicting score was developed. On internal validation and regression, the score was found 80% accurate with error limits ± 6 months. It is a concise comprehensive score applicable on Indian population with history of tobacco chewing. It will not only help clinicians to tell patients about their survival expectancy but also help to counsel them for adjuvant therapy. However, external validation and if required recalibration incorporating other factors need to be done for this score.

Histiocytic Sarcoma of Tibia: A Rare Case Report and Review of Literature.

Ajita KendreHistiocytic sarcoma is a rare disorder and there has been a lot of confusion and debate regarding its diagnosis and treatment. The World Health Organization (WHO) in 2008 aided in the standardization of diagnosis of histiocytic sarcoma; however, the treatment protocols are still not clear and the treatment is on the line of other hematological malignancies. This study intends to report a rare case of histiocytic sarcoma and the treatment protocol used and analysis of available literature. The usual sites of histiocytic sarcoma are the lymphoreticular system, skin, and gastrointestinal tract, but solitary bone involvement is rare. This disease being a localized one was treated locally with surgical curettage followed by radical radiation therapy. Systemic therapy was not offered to this patient and has been reserved in case a patient gets a systemic recurrence as done in most cases of B cell lymphoma. Based on follow-up until now, the patient is disease-free and doing well. Thus, this treatment protocol appears apt for this concerned patient; however, there is a need for a large-scale analysis of various reported cases to establish a standardized treatment protocol for this rare and aggressive disease.

Sebaceous Lymphadenoma of Parotid: Case Report of a Rare Entity.

Sebaceous differentiation can be normally seen in salivary glands. An entity first described by Hamperi. Sebaceous components are present in several salivary gland tumors like Warthin's tumor and mucoepidermoid tumor. But, if the sebaceous component predominates, it is known as a sebaceous adenoma. If lymphatic stroma in the background is prominent, it qualifies as sebaceous lymphadenoma. The term was coined and properly described by McGavran et al., differentiating it from similar appearing tumors like Warthin's tumor, sebaceous adenoma, and mucoepidermoid tumor. Clinicians, as well as pathologists, need to be aware of this entity as it is known to undergo malignant degeneration. Since it is a benign entity, the most common symptom is painless parotid swelling. The patient in this case also presented with painless parotid swelling and underwent preoperative FNAC and MRI. But, the diagnosis was made after surgical excision. The patient recovered well after surgery and is being followed. Since this disease is known for malignant degeneration and recurrence careful diagnosis is required. Histopathological picture may be confused with other common entities like Warthin also known as papillary cystadenoma lymphomatosum since both have sebaceous and lymphoid components. McGavran differentiated between both entities. Sebaceous lymphadenoma can convert to sebaceous adenocarcinoma and is thus important to know the correct diagnosis, even if it is postoperative since recurrence may be associated with malignant changes. Sometimes, the picture may be confused with lymphoma and in that case, immunotyping can come as a rescue for diagnosis. The authors of this report intend to report this rare entity and emphasize the need for clinicians and pathologists being aware of it and keeping it as a differential while dealing with a similar parotid tumor.

Comparison of the Clinical Outcome and Complications in Laparoscopic Hernia Repair of Inguinal Hernia With Mesh Fixation Using Fibrin Glue vs Tacker.

Although laparoscopic repair offers a quick and less morbid way of treating hernias, complications like hematoma, seroma, neuralgia, recurrence, mesh infection, hydrocele, etc. are known. The present study was undertaken to compare various clinical outcomes between mesh fixation using fibrin glue and mesh fixation with tacker in a 3-months follow-up. One hundred patients aged 18 to 60 years having inguinal hernia admitted in Poona Hospital and Research Centre, Pune, between October 2012 and November 2014 for laparoscopic hernia surgery and ready to participate in this study were included. All of them underwent laparoscopic repair of hernia by total extra peritoneal (TEP) method following sample surgical protocol in all of them except for method of mesh fixation. Mean time calculated from insertion of the first trocar to beginning of skin suturing was 54.9 min in tacker group and 50.3 min in fibrin glue group with no statistically significant difference between the two. The incidence of urinary retention was significantly higher in tacker (34 %) as compared to fibrin glue (12 %) group. Incidence of hematoma was significantly higher in tacker group in 15-day follow-up, but there was no significant difference in hematoma formation at hernial sites in both groups after 15 days of follow-up. The incidence of neuralgia was significantly higher in the tacker group (24 %) compared with the fibrin glue group (2 %). Significantly, more number of people in the fibrin glue group 68 and 90 %, respectively, returned to work during 15 and 30 days follow-up as compared to the tacker group 46 and 64 %. Fibrin glue can be considered as an alternative to tacker for mesh fixation.

Submental orotracheal intubation: A better alternative to tracheostomy in panfacial fractures.

Surgical repair of complex maxillofacial trauma presents a challenge to the surgeon and anaesthetist. Submental intubation is an alternative where oral and nasal intubation cannot be used. We present a case where tracheostomy was avoided in a patient with multiple maxillofacial fractures by opting for sub-mental endotracheal intubation technique. Time required for intubation, accidental extubation, postoperative complications, and the healing of intraoral and submental scars were evaluated. The technique avoids the complications associated with tracheostomy.