Central Pancreatectomy for Bilobed Solid Pseudopapillary Tumor of Pancreas.

Solid-pseudopapillary tumor of pancreas is a rare pancreatic tumor that occurs predominantly in a young female with only a small minority concerning children. These tumors have low malignant potential, found incidentally which are usually single lobed. Surgical resection remains the mainstay of treatment. Our case is 26 years female with vomiting and abdominal pain localized to the right upper quadrant. Computerized tomography scans showed two well-defined hypodense lesions at neck and body of the pancreas with greatest diameter of six centimeter. The patient underwent central pancreatectomy and histopathology confirmed solid-pseudopapillary tumor with complete resection with all resected margin free of tumor. Symptoms may be present such as abdominal pain or vomiting due to compression, mainly in large tumors. In benign cases parenchyma sparing surgery such as central pancreatectomy can preserve the exocrine and endocrine function of pancreas which helps patient to have better postoperative quality of life.

NATURALLY OCCURRING RADIONUCLIDE 40K BODY CONTENT OF KAKRAPAR GUJARAT SITE POPULATION.

An attempt was made to investigate the naturally occurring radionuclide 40K body content of the Kakrapar Gujarat Site (India) population by using whole-body counting method. The population comprises occupational workers (regular and contract personnel working at Kakrapar Atomic Power station) and students from various educational institutions. A total of 1056 subjects of different age groups and gender were monitored for 40K body content by using a Standfast-II Whole Body Counting System. The reactor released radionuclides such as 137Cs, 60Co and 131I are not detected in occupational workers of Kakrapar Atomic Power station which indicates that occupational workers are free from radioactive contamination. Based on the activity measurement, an effective dose due to 40K was estimated for different groups of the site population based on the dietary habits, sex and age. Statistical significant correlation was not observed in any of the groups. The annual effective dose due to 40K was found to be in the range of 52-243 µSv y-1 with an average of 133 ± 35 µSv y-1 for the vegetarian group (588 subjects), 60-223 µSv y-1 with an average of 136 ± 35 µSv y-1 for the non-vegetarian group (468 subjects), 52-243 µSv y-1 with an average of 134 ± 35 µSv y-1 for the male group (1007 subjects) and 67-203 µSv y-1 with an average of 128 ± 35 µSv y-1 for the female group (49 subjects), respectively. Among the four age groups of the population studied, an effective dose due to 40K is slightly higher in the age group of 20-29 (161 subjects). The annual effective dose due to 40K reported by UNSCEAR, 1982(3) is 180 µSv y-1.

Development of electronic record-keeping software for remote participation in Large Volume Plasma Device upgrade using Angular 2 and NodeJS web technologies.

In an era of digital transformation and collaborations, the Web Information System (WIS) becomes an essential requirement for the information and data sharing of large experimental facilities among users. With the enhancement in the capabilities and performance of web technologies, sharing of experimental data using a flexible, modular, secure, and robust mechanism is feasible. In this direction, the Large Volume Plasma Device (LVPD), an experimental device dedicated for carrying out investigations for unfolding physical phenomena of relevance to Earth's magnetosphere and fusion plasmas, also adopts web-based electronic record keeping for its operation. The nature of investigations is concerned with plasma turbulence of electron scale, induced anomalous plasma transport and mitigation of energetic electrons by excited whistler turbulence that requires large scale, and simultaneous multiple point measurements from different electrostatic and electro-magnetic diagnostics. This paper discusses the WIS implementation in LVPD for the experimental configuration, information logging, and preliminary data analysis. The architecture of the system is spread over three tiers covering application, data, and presentation layers. The presentation layer is developed using the Angular 2 framework on the progressive web application architecture. The application and data layers are developed using NodeJS and PostgreSQL, respectively. The novelty of this paper lies in the integrated application development approach and applicability of the latest web technologies in the scientific and experimental domains. This paper discusses the literature survey of similar developments at other places, requirements, scopes, development artifacts, adapted tools and technologies, obtained results from actual plasma discharges of LVPD, and future enhancements.

A massive rock and ice avalanche caused the 2021 disaster at Chamoli, Indian Himalaya.

On 7 February 2021, a catastrophic mass flow descended the Ronti Gad, Rishiganga, and Dhauliganga valleys in Chamoli, Uttarakhand, India, causing widespread devastation and severely damaging two hydropower projects. More than 200 people were killed or are missing. Our analysis of satellite imagery, seismic records, numerical model results, and eyewitness videos reveals that ~27 × 106 cubic meters of rock and glacier ice collapsed from the steep north face of Ronti Peak. The rock and ice avalanche rapidly transformed into an extraordinarily large and mobile debris flow that transported boulders greater than 20 meters in diameter and scoured the valley walls up to 220 meters above the valley floor. The intersection of the hazard cascade with downvalley infrastructure resulted in a disaster, which highlights key questions about adequate monitoring and sustainable development in the Himalaya as well as other remote, high-mountain environments.

Anal cancer survival: a socioeconomic analysis.

INTRODUCTION: Squamous cell carcinoma is the most common variant of anal malignancy. Certain disease-related factors have been established in determining survival. These include tumour size, differentiation and nodal involvement. Other factors such as HIV status, human papillomavirus infection, smoking and socioeconomic disparity may have important roles, however few data are available on the UK population. We aim to correlate social deprivation and survival of anal cancer patients at a tertiary centre. MATERIALS AND METHODS: All consecutive cases diagnosed with anal squamous cell carcinoma and treated as per local protocol between July 2010 and April 2017 were included. The pathological and demographical details were collected from a prospectively maintained database. Socioeconomic deprivation was defined for each postcode using the Index of Multiple Deprivation decile compiled by local governments in England. Survival was estimated using Kaplan-Meier analysis and Cox regression was used to investigate the effect of different factors on overall survival. RESULTS: A total of 129 patients with anal squamous cell carcinoma over a median follow-up of 43 months were included. Overall survival for the entire patient cohort was 87.7% (95% confidence interval, CI, 82.0-93.7%), 75.5% (95% CI 67.5-84.5%) and 68.9% (95% CI 59.7-79.6%) at one year, three years and five years, respectively. On multivariate analysis, Index of Multiple Deprivation and income do not significantly influence overall survival (p = 0.79, hazard ratio, HR, 1.07; 95% CI 0.61-1.63), (p = 0.99, HR=1.00; 95% CI 0.61-1.63), respectively. Increased risk of death was observed for male sex (p = 0.02, HR=2.80; 95% CI 1.02-5.50) and larger tumour size (p = 0.01, HR=1.64; 95% CI 1.12-2.41). CONCLUSION: In contrast to US studies, there is little difference in survival between the least deprived and most deprived groups. We attribute this to equal access to intensity-modulated radiation therapy-based chemoradiotherapy. Thus, a highly effective treatment made available to all mitigates any survival difference between socioeconomic groups.

Toxicity and survival of anal cancer patients treated with intensity-modulated radiation therapy.

INTRODUCTION: The definitive treatment of anal cancer with chemoradiotherapy spares abdominoperineal resection for salvage treatment but carries a high burden of toxicity. Intensity-modulated radiation therapy has been implemented to reduce toxicity, reduce treatment breaks and improve survival. However, large and long-term studies are lacking. We aimed to investigate the toxicities and long-term survival of anal cancer patients treated with intensity-modulated radiation therapy at James Cook University Hospital, Middlesbrough. MATERIALS AND METHODS: We conducted a retrospective analysis of all patients with squamous cell anal cancer treated at James Cook University Hospital between July 2010 and April 2017. All patients were uniformly treated with intensity-modulated radiation therapy-based chemoradiation with curative intent. A subset of these patients was followed-up prospectively by an oncologist for acute and late toxicity. We calculated Kaplan-Meier estimates of survival statistics and compared our results with those of previous trials which used conventional radiotherapy. RESULTS: We studied 132 patients, including a toxicity subset of 64, for a median follow-up time of 43 months (range 3-84 months). Eleven patients (8.3%) underwent salvage abdominoperineal resection. Grade 3+ acute non-haematological, gastrointestinal, genitourinary and dermatological toxicity were found in 56.2%, 12.3%, 0% and 50.7% of the toxicity subset (n = 64). Median treatment duration was 37 days. Overall and colostomy-free survival at five years were 68.3% and 85.3%, respectively. Tumour size (P = 0.006) and age (P = 0.002) predicted shorter overall survival. CONCLUSIONS: Intensity-modulated radiation therapy probably reduces acute gastrointestinal and genitourinary toxicity compared with conventional radiotherapy, while resulting in similar overall and colostomy-free survival. We suggest that further dose escalation may improve survival in patients with T3/T4 tumours.

Ethnic Variations of Blood Groups in a Medical College of Eastern Nepal.

Background Red blood cells contain antigens in its membrane which are inherited according to Mendelian law. ABO and Rhesus blood group systems are considered the most important blood group systems for clinical procedures, blood transfusion, organ transplantation, anthropological study and medico-legal purposes. Determination of ABO and Rhesus blood groups and its frequency distribution in a multiethnic country like Nepal is important for effective management of blood banks, safe blood transfusion services. The trend of blood groups and its ethnic distributions in the eastern part of Nepal is still unknown. Objective To find the distribution of blood groups among the subjects of different ethnic groups of eastern Nepal. Method A cross-sectional perspective study was carried out among the subjects visited in the laboratory of Nobel Medical College, Biratnagar, Nepal for a period of one year from August 1, 2015 to July 30, 2016. Result The 11,960 subjects were included in the present study, among which 5012 were males and 6948 were females. The study revealed that in ABO system, blood group distribution was 34.80% O, 28.66% A, 27.66% B and 6.89% AB. With regard to Rh blood group system, Rhesus +ve was 96.79% and Rhesus -ve was 3.21%. O blood group dominant ethnic groups were Brahmin, Bhujel, Biswakarma, Shah, Gurung, Marwari, Magar, Mahato, Mandal, Newar, Sanyasi, Tamang, Terai Brahmin and Yadav. Similarly, blood group A dominant ethnic groups were Chhetri, Dhimal, Limbu, Rai and Muslim. Howerver, blood group B was dominant in ethnic groups, namely Biswakarma, Rajput, Satar and Tharu. Conclusion The frequency distribution pattern of ABO blood group was observed as O > A> B > AB and in Rhesus system, Rhesus +ve > Rhesus -ve. Variation in blood groups distribution was observed in various ethnic groups.

Short-term surgical outcomes and patient quality of life between robotic and laparoscopic extralevator abdominoperineal excision for adenocarcinoma of the rectum.

Introduction Some studies advocate a laparoscopic extralevator abdominoperineal excision (l-ELAPE) approach for low rectal cancer. The da Vinci™ robot (r-ELAPE) technique has potential to overcome some limitations of l-ELAPE, such as reduction of the learning curve and more precise tissue handling. It is unknown whether this approach results in improved surgical or quality of life outcomes compared with l-ELAPE. This study aimed to address this issue. Methods Consecutive patients having undergone either robotic or laparoscopic ELAPE for adenocarcinoma were studied. All operations were performed by two surgeons experienced in laparoscopic and recently introduced robotic surgery. Surgical outcomes were determined by postoperative histology and short-term complications. Quality of life was prospectively assessed using the European Organisation for Research and Treatment of Cancer QLC-CR30 and QLC-CR29 questionnaires. Results A total of 22 patients (11 r-ELAPE) with a median follow-up of 13 months (8 months robotic; 22 months laparoscopic) were studied. The groups were similarly matched for age, gender, American Society of Anesthesiologists status, preoperative chemoradiotherapy and tumour height. All had R0 resection. There was no significant difference in short-term surgical outcomes between groups. There was no significant difference in mean global health scores between the two groups (74 ± 14 r-ELAPE vs. 73 ± 10 l-ELAPE). The r-ELAPE group had a lower mean impotence score compared with the I-ELAPE group (55.5 ± 40 vs. 72.2 ± 44), although this was not statistically significant. Conclusions The newly introduced r-ELAPE was non-inferior to l-ELAPE in either patient quality of life or surgical outcomes. Robotic surgery could be particularly beneficial in the technically challenging area of low rectal cancer surgery with a shorter learning curve than laparoscopy.

Patient quality of life and short-term surgical outcomes between robotic and laparoscopic anterior resection for adenocarcinoma of the rectum.

PURPOSE: To compare patient quality of life (QoL) and short-term surgical outcomes between robotic anterior resection (r-AR) and laparoscopic (l-AR) approach. METHODS: Consecutive patients having undergone either robotic or laparoscopic AR for adenocarcinoma were studied. All operations were performed by two surgeons experienced in laparoscopic and recently introduced robotic surgery. Surgical outcomes were determined by post-operative histology and short-term complications. QoL was prospectively assessed using the EORTC QLC-CR30 and QLC-CR29 questionnaires. RESULTS: In total, 36 patients (18 r-AR) with a median follow-up of 12 months following surgery (9-month robotic and 20-month laparoscopic) were studied. The two groups were similarly matched for age and gender. Laparoscopic patients had a lower ASA grade (p = 0.02). There was no significant difference in surgical outcomes between groups. r-AR patients reported lower pain scales (2 ± 6 vs. 11 ± 13) (p = 0.04), lower levels of insomnia 0 vs. 8 ± 15 (p = 0.04) and a lower abdominal pain scale (2 ± 9 vs. 17 ± 27) (p = 0.04). Male impotence scores were higher in l-AR 33 ± 35 compared to r-AR 7 ± 21 (p = 0.03). CONCLUSION: Despite its recent introduction to our centre, the quality of oncological resection using the robotic surgery is comparable to laparoscopy. Lower impotence and QoL scores in patients after robotic procedure may be explained on the basis of better visualisation and precise tissue handling.

Solution phase synthesis and intense pulsed light sintering and reduction of a copper oxide ink with an encapsulating nickel oxide barrier.

Copper oxide nanoparticle inks sintered and reduced by intense pulsed light (IPL) are an inexpensive means to produce conductive patterns on a number of substrates. However, the oxidation and diffusion characteristics of copper are issues that must be resolved before it can be considered as a viable solution. Nickel can provide a degree of oxidation protection and act as a barrier for the diffusion of copper. In the present study we have for the first time synthesized copper oxide with an encapsulating nickel oxide nanostructure using a solution phase synthesis process in the presence of a surfactant at room temperature. The room temperature process enables us to easily prevent the formation of alloys at the copper-nickel interface. The synthesis results in a simple technique (easily commercializable, tested at a 10 g scale) with highly controllable layer thicknesses on a 20 nm copper oxide nanoparticle. These Cu(2)O@NiO dispersions were then directly deposited onto substrates and sintered/reduced using an IPL source. The sintering technique produces a highly conductive film with very short processing times. Films have been deposited onto silicon, and the copper-nickel structure has shown a lower copper diffusion. The nanostructures and resulting films were characterized using electron and x-ray spectroscopy, and the films' resistivity was measured.

Toll-like receptors and CD40 modulate each other's expression affecting Leishmania major infection.

Toll-like receptors (TLRs) recognize pathogen-associated molecular patterns and results in innate immune system activation that results in elicitation of the adaptive immune response. One crucial modulator of the adaptive immune response is CD40. However, whether these molecules influence each other's expression and functions is not known. Therefore, we examined the effects of TLRs on CD40 expression on macrophages, the host cell for the protozoan parasite Leishmania major. While polyinosinic-polycytidylic acid [poly (I:C)], a TLR-3 ligand, lipopolysaccharide (LPS), a TLR-4 ligand, imiquimod, a TLR-7/8 ligand and cytosine-phosphate-guanosine (CpG), a TLR-9 ligand, were shown to enhance CD40 expression, CD40 stimulation enhanced only TLR-9 expression. Therefore, we tested the synergism between CD40 and CpG in anti-leishmanial immune response. In Leishmania-infected macrophages, CpG was found to reduce CD40-induced extracellular stress-regulated kinase (ERK)1/2 activation; with the exception of interleukin (IL)-10, these ligands had differential effects on CD40-induced IL-1α, IL-6 and IL-12 production. CpG significantly enhanced the anti-leishmanial function of CD40 with differential effects on IL-4, IL-10 and interferon (IFN)-γ production in susceptible BALB/c mice. Thus, we report the first systematic study on CD40-TLR cross-talk that regulated the experimental L. major infection.

Leishmania expressed lipophosphoglycan interacts with Toll-like receptor (TLR)-2 to decrease TLR-9 expression and reduce anti-leishmanial responses.

Two different Toll-like receptors (TLRs) have been shown to play a role in host responses to Leishmania infection. TLR-2 is involved in parasite survival in macrophages upon activation by lipophosphoglycan (LPG), a virulence factor expressed by Leishmania. In contrast, activation of TLR-9 has been shown to promote a host-protective response. However, whether there is a relationship between the interaction of LPG and TLR-2, on one hand, with the effect of TLR-9, on the other hand, remains unknown. In this study, we report that in-vitro infection of macrophages with a L. major parasite with high expression levels of LPG results in decreased TLR-9 expression compared to infection with a L. major parasite with lower expression levels of LPG. Addition of anti-LPG as well as anti-TLR-2 antibodies prevents this reduction of TLR-9 expression. Also, the addition of purified LPG to macrophages results in a decrease of TLR-9 expression, which is shown to be mediated by transforming growth factor (TGF)-ß and interleukin (IL)-10. Finally, in-vitro treatment of macrophages with anti-LPG and/or anti-TLR-2 antibodies before infection reduces the number of amastigotes in macrophages and co-treatment of mice with anti-TLR-2 antibodies and cytosine-phosphate-guanosine (CpG) reduces footpad swelling and parasite load in the draining lymph nodes, accompanied by an interferon (IFN)-γ-predominant T cell response. Thus, for the first time, we show how interactions between LPG and TLR-2 reduce anti-leishmanial responses via cytokine-mediated decrease of TLR-9 expression.

Development of novel nanocomposite membrane for water purification.

In the area of water purification, nanotechnology provides efficient removal of pollutants and germs. Electrospun nanofibers membrane has a potential for water purification due to its high large surface area, and good mechanical strength. In the present study, PAMAM dendrimers composite nylon-6 nanofibers membrane was prepared by crosslinking method using glutaraldehyde. Modified membrane has drastically improved water purification efficiency. Further, the efficacy of the modified membrane can be renewed by mere exposure of the saturated membrane with the solution having acidic pH. The modified membrane can be used as an effective tool for water purification.

Sulfide oxidation in fluidized bed bioreactor using nylon support material.

A continuous fluidized bed bioreactor (FBBR) with nylon support particles was used to treat synthetic sulfide wastewater at different hydraulic retention time of 25, 50 and 75 min and upflow velocity of 14, 17 and 20 m/hr. The effects of upflow velocity, hydraulic retention time and reactor operation time on sulfide oxidation rate were studied using statistical model. Mixed culture obtained from the activated sludge, taken from tannery effluent treatment plant, was used as a source for microorganisms. The diameter and density of the nylon particles were 2-3 mm and 1140 kg/m3, respectively. Experiments were carried out in the reactor at a temperature of (30 +/- 2) degrees C, at a fixed bed height of 16 cm after the formation of biofilm on the surface of support particles. Biofilm thickness reached (42 +/- 3) microm after 15 days from reactor start-up. The sulfide oxidation, sulfate and sulfur formation is examined at all hydraulic retention times and upflow velocities. The results indicated that almost 90%-92% sulfide oxidation was achieved at all hydraulic retention times. Statistical model could explain 94% of the variability and analysis of variance showed that upflow velocity and hydraulic retention time slightly affected the sulfide oxidation rate. The highest sulfide oxidation of 92% with 70% sulfur was obtained at hydraulic retention time of 75 min and upflow velocity of 14 m/hr.

Application of Central Composite Design approach for removal of chromium (VI) from aqueous solution using weakly anionic resin: modeling, optimization, and study of interactive variables.

In this paper, response surface methodology (RSM) approach using Central Composite Design (CCD) is applied to develop mathematical model and optimize process parameters for Cr (VI) removal from aqueous streams using weakly anionic resin Amberlite IRA 96. The individual and combined effect of four process parameters, i.e. contact time, initial solution pH, initial Cr (VI) concentration and resin dose on Cr adsorption were studied. Analysis of variance (ANOVA) showed the relative significance of process parameters in removal process. Initial solution pH and resin dose were found to be more significant than contact time and initial Cr (VI) concentration. The second-order regression model was developed to predict the removal efficiency using Design Expert software. The optimal conditions to remove Cr from aqueous solution at constant temperature of 30°C and stirring speed of 250 rpm were found to be contact time 62.5 min, pH 1.96, initial Cr (VI) concentration 145.4 mg/L, and resin dose 8.51 g/L. At these conditions, high removal efficiency (93.26%) was achieved. FTIR and EDX analysis were conducted to interpret the functional groups involved during the Cr-resin interaction.

Mesenteric fat necrosis after recent surgery causing bowel obstruction: a case report and review of the literature.

Mesenteric fat necrosis causing bowel obstruction is a rare occurrence with only one case reported in humans. It is due to accidental or surgical trauma to the adipose tissue with extracellular liberation of fat or enzymatic lysis of fat due to the release of lipases resulting in fibrosis. Preoperative imaging may often be misleading and fail to identify fat necrosis as the cause of bowel obstruction. As surgical intervention is the only suitable treatment option in cases of failed conservative treatment, the diagnosis is made postoperatively. There is no published advice on the management of mesenteric fat necrosis. We recommend safe operating techniques to minimize the risk of developing fat necrosis and its potential harmful consequences.

An integrated approach to remove Cr(VI) using immobilized Chlorella minutissima grown in nutrient rich sewage wastewater.

The potential of an integrated system for sewage wastewater treatment and biosorption of chromium(VI) was evaluated using immobilized Chlorella minutissima cells. Immobilized algal cells were grown in sewage wastewater in designed photobioreactor for 48 h and then subjected to removal of Cr(VI) from synthetic wastewater. The effect of pH, Cr(VI) concentration, biosorbent dose on Cr(VI) removal was investigated. C. minutissima showed a higher NH(4)(+)-N and PO(4)(3-)-P removal efficiency (above 99% removal) than the NO(3)(2-)-N (58% removal) in 48 h. Biosorption of Cr(VI) was found to be highly dependent on solution pH, biosorbent dose and initial Cr(VI) concentration. Maximum Cr(VI) uptake 57.33 mg Cr(VI)/g dry biosorbent/L of solution was observed at pH2 with 20% (w/v) biosorbent. Further more than 90% of total Cr adsorbed could be recovered using 0.5 M NaOH as desorption medium.

Population dynamics and identification of efficient strains of Azospirillum in maize ecosystems of Bihar (India).

Information on inoculum load and diversity of native microbial community is an important prerequisite for crop management of microbial origin. Azospirillum has a proven role in benefiting the maize (Zea mays) crop in terms of nutrient (nitrogen) supply as well as plant growth enhancement. Bihar state has highest average national maize productivity although fertilizer consumption is minimum, indicating richness of Azospirillum both in terms of population and diversity in soils. An experiment was planned to generate basic information on Azospirillum population variation in maize soils under different agricultural practices and soil types of Bihar, to identify suitable agricultural practices supporting the target microorganism and efficient Azospirillum strain(s). No tillage, growing traditional maize cultivar, land use history (diara soil having history of maize cultivation), soil organic carbon (>1%) and intercrop with oat supported prevalence of Azospirillum in maize rhizosphere. Native Azospirillum population varied from 1 million to 1 billion/g soil under diverse agricultural practices and soil types. Such richness, however, does not necessarily mean that artificial inoculation of Azospirillum is not required in Bihar soils as 92% of Azospirillum isolates (50 isolates) were poor in nitrogen-fixing ability and 88% were poor on IAA production. Efficient strains of Azospirillum based on growth (three), acetylene reduction assay (three), IAA production (three), broad range of pH (two) and temperature tolerance were identified. The findings suggested that maize crop in Bihar should be inoculated in universal mode rather than site-specific mode.

Transverse facial cleft: A series of 17 cases.

INTRODUCTION: Transverse facial cleft (Tessier type 7) or congenital macrostomia is a rare congenital anomaly seldom occurring alone and is frequently associated with deformities of the structures developing from the first and second branchial arches. The reported incidence of No. 7 cleft varies from 1 in 60,000 to 1 in 300,000 live births. MATERIAL AND METHODS: Seventeen patients of transeverse facial cleft who presented to us in last 5 years were included in the study. Their history regarding familial and environmental predispositions was recorded. The cases were analysed on basis of sex, laterality, severity, associated anomalies and were graded according to severity. They were operated by z plasty technique and were followed up for 2 years to look for effectiveness of the technique and its complications. RESULT: Out of the seventeen patients of transverse cleft, none had familial predilection or any environmental etiology like antenatal radiological exposure or intake of drugs of teratogenic potential. Most of the patients (9/17) were associated with hemifacial microsomia and 1 patient was associated with Treacher Colin's Syndrome. Out of the 6 cases of Grade I clefts, 4 were isolated transverse clefts and of the 10 patients of Grade II clefts, 7 were associated with hemifacial microsomia. We encountered only one case of Grade III Transverse Cleft which was not only associated with hemifacial microsomia but also had cardiac anomaly. Out of the 17 cases, 15 were operated and in most of them the outcome was satisfactory.