A study of unprotected left main intervention in the ACS population 2013-2018.

OBJECTIVES: Our objectives were to evaluate the outcomes of left main percutaneous coronary interventions in Acute Coronary Syndrome population. METHODS: This is a retrospective& observational study. Primary endpoint is a composite of death, stent thrombosis/MI, target lesion revascularization. Secondary endpoints include individual components of the primary events analyzed separately. RESULTS: Seventy five patients, two year follow - up data was analyzed. The primary event analysis showed that the Elective Double Stent (EDS) group had a higher primary events (36% vs. 14%, p value - 0.008, Hazard ratio - 0.76 (0.51-1.15, 95% CI), in secondary event analysis stent thrombosis (ST)/Myocardial infarction (MI) rates were higher in EDS group (8% Vs 36%, p Value - 0.008, Hazard ratio- 0.63(0.35-1.14, 95%CI), there is no difference in target lesion revascularization (TLR)and death rates in both the groups. CONCLUSIONS: The provisional strategy is better than EDS in treatment of left main bifurcation lesions in the ACS population.

Validity of 3-Tesla diffusion-weighted magnetic resonance imaging for distinction of reactive and metastatic lymph nodes in head-and-neck carcinoma.

OBJECTIVES: The objective was to study the relationship of 3-Tesla (3T) diffusion-weighted magnetic resonance imaging (DW-MRI) with apparent diffusion coefficient (ADC) value for distinction of reactive and metastatic lymph nodes (LNs) in head-and-neck carcinoma (HNC) patients and to determine the ADC cutoff value for metastatic LNs at various levels. MATERIALS AND METHODS: 3T DW and T1- and T2-weighted imaging sequences were done in 34 patients with biopsy-proven primary HNC of 100 cervical LNs ≥1 cm in diameter. The mean ADC values were compared with histopathologically proven LNs using the independent t-test. ADC cutoff value was evaluated with sensitivity, specificity, accuracy, positive predictive value, negative predictive value and a receiver operating characteristic curve analysis. RESULTS: The mean ADC value of reactive LN was 1.2933 × 10-3 mm2/s and metastatic LN was 0.908 × 10-3 mm2/s. An ADC cutoff value was 0.868 × 10-3 mm2/s with 84% sensitivity, 96% specificity, 93% accuracy, 87.5% positive predictive value, and 94.7% negative predictive value. A significant difference in mean ADC value between reactive and metastatic LNs was noted (P< 0.001). CONCLUSION: 3T DW-MRI is useful in differentiating reactive and metastatic cervical LNs in HNC patients. However, studies with larger sample size have to be performed to validate ADC threshold value with 3T DW-MRI in differentiating between reactive and metastatic LNs for clinical practice.

Prediction of age and gender using digital radiographic method: A retrospective study.

AIM AND OBJECTIVE: To investigate age, sex based on gonial angle, width and breadth of the ramus of the mandible by digital orthopantomograph. MATERIALS AND METHODS: A total of 200 panoramic radiographic images were selected. The age of the individuals ranged between 4 and 75 years of both the gender - males (113) and females (87) and selected radiographic images were measured using KLONK image measurement software tool with linear, angular measurement. The investigated radiographs were collected from the records of SRM Dental College, Department of Oral Medicine and Radiology. Radiographs with any pathology, facial deformities, if no observation of mental foramen, congenital deformities, magnification, and distortion were excluded. RESULTS: Mean, median, standard deviation, derived to check the first and third quartile, linear regression is used to check age and gender correlation with angle of mandible, height and width of the ramus of mandible. CONCLUSION: The radiographic method is a simpler and cost-effective method of age identification compared with histological and biochemical methods. Mandible is strongest facial bone after the skull, pelvic bone. It is validatory to predict age and gender by many previous studies. Radiographic and tomographic images have become an essential aid for human identification in forensic dentistry forensic dentists can choose the most appropriate one since the validity of age and gender estimation crucially depends on the method used and its proper application.

Rhinosporidiosis presenting as a facial swelling: a case report.

Rhinosporidiosis caused by Rhinosporidium seeberi is a fungal infection, which affects chiefly the mucus membranes of the nose, oropharynx, and nasopharynx, as well as the larynx, skin, eyes, and genital mucosa. Soil and water act as a reservoir for the organism. Here, we present a case of Rhinosporidiosis, which clinically manifested as a facial swelling indicating that fungal infections should also be considered as one of the differential diagnoses whenever facial swellings are encountered.

Pre-operative contrast enhanced computer tomographic evaluation of cervical nodal metastatic disease in oral squamous cell carcinoma.

AIMS: This prospective study was undertaken to evaluate the contrast enhanced computed tomography (CECT) criteria in detecting cervical lymph node metastasis in 50 patients with an oral squamous cell carcinoma (OSQCC). MATERIALS AND METHODS: A total of 50 patients with OSQCC who underwent clinical assessment, routine CECT scanning of cervical lymph node and radical neck dissection were analyzed. Radiologic criteria for diagnosing nodal metastasis in this imaging study were: A nodal size of 1 cm, the presence of central lucency despite the size of the lymph node and grouping of lymph nodes. These criteria were based on modified American Joint Committee on Cancer Radiological Nodal Staging Guidelines. STATISTICAL ANALYSIS: Chi-square test/Fisher Exact test has been used to find the significant association of findings. Diagnostic statistics viz.: Sensitivity, specificity, positive predictive value (PPV), negative predictive value, and diagnostic accuracy were obtained. The results were considered significant when P value was less than 0.05. RESULTS: On using a nodal size of 1 cm and the presence of central nodal necrosis (CNN) as radiological criteria for nodal metastasis CT scanning staged 23 of the 27 histopathologically positive necks, providing accuracy of 88%, sensitivity of 92%, and specificity of 84% in detection of nodal metastasis. A significant relationship between the incidence of CNN, different nodal densities, and primary tumor differentiation was observed. CONCLUSIONS: The nodal size cut-off of 1-1.5 cm had a maximal sensitivity of 90.91% and PPV of 86.96%. Furthermore, observation of nodal densities in the absence of frank CNN on the CT scan may be necessary especially in low grade primary tumor. CT assessment of cervical node metastasis was found acceptable, although adjuncts like ultrasound guided fine needle aspiration may further increase efficacy of CT scan in nodes lesser than 1 cm in size.

Multiple internal resorption in permanent teeth associated with hyperparathyroidism.

Internal resorption has been described as a resorptive defect of internal aspect of tooth. It is caused by transformation of normal pulp tissue into granulomatous tissue with giant cells which resorb dentin. Though mostly idiopathic in origin, trauma, caries and restorative procedures have also been suggested to be contributing factors of internal resorption of pulp. Most of the internal resorption cases were found on isolated individual tooth. There are few case reports on multiple root resorptions. External root resorption have been frequently associated with systemic disorders like renal diseases hyperparathyroidism, rickets etc. A rare association of multiple internal resorption of permanent teeth (including lateral incisors, canines, premolars, sparing 2 nd and 3 rd. Permanent molars and missing 35,36, 42) with elevated levels of PTH and uric acid was evident in a 28 year old female patient who presented with fracture of crowns of permanent teeth. Though many cases related to dental manifestations of chronic renal disease and internal resorption of permanent teeth have been documented in literature, there is no evidence on association of hyperparathyroidism with multiple internal resorptions of teeth.

Quality of life outcome measures using UW-QOL questionnaire v4 in early oral cancer/squamous cell cancer resections of the tongue and floor of mouth with reconstruction solely using local methods.

Cancer treatment either by surgery alone or in a combination of surgery, radiotherapy±chemotherapy has significant consequences on the physical, mental, emotional and psychosocial wellbeing of the patient. Measurement of quality of life (QOL) is necessary to understand the patient's perception of their own treatment, as clinicians' views can be biased. Reconstruction of a cancerous defect with a free vascular flap is ideal in large, often composite defects, provided it is appropriate to the advanced stage and prognosis of the disease, medical condition of the patient, availability of surgical and financial resources and allows the prosthetic rehabilitation of the anatomic area. Using University of Washington Quality of life 4 questionnaire (UW-QOL4), we assessed the QOL of 38 patients, who underwent local surgical reconstructions after resection of T1/T2 tongue/floor of mouth squamous cell carcinoma defects. Objective assessment of speech and swallow function was also carried out using therapy outcome measure (TOM) scores by the speech and language therapy team (SALT) aiming to see the differences in the scores obtained in patients who underwent post-operative radiotherapy. Our study, conducted 6months after completion of all oncologic treatment for the primary disease, showed satisfactory levels of quality of life parameters with good function showing that local reconstructive methods are successful and may have benefits in the management of early oral cancers involving the tongue and floor of mouth. They are beneficial by providing a good quality in terms of function, by reducing the operating time, the surgical morbidity, simplifying post-operative care and thereby becoming an efficient, effective and a cost effective method.

Evaluation of extensions of sinonasal mass lesions by computerized tomography scan.

INTRODUCTION: Cross-sectional imaging has had a significant impact on the management of the sinonasal malignancy. Staging of these lesions has been closely monitored by dependence on computerized tomography (CT) scan and now in small proportion with MRI. The objective of the study was to evaluate the reliability of CT scan in assessing the extensions of the sinonasal mass lesions and their impact on tumor staging. MATERIALS AND METHODS: All cases of sinonasal lesions were reviewed retrospectively from June 2001 to May 2006 (five years) at KMIO, Bangalore. Only those cases that had CT scan reports and Histopatholgy Examination (HPE) reports were included in the study. All the cases, which were subjected to radiotherapy prior to surgery, were excluded from the study. There were a total of 38 cases with slight male preponderance. Tumor staging was done according to the sixth edition of TNM classification of malignant tumors. Two observers evaluated all the cases (Blinded Study) and sensitivity, specificity, positive predictive value, negative predictive value and predictive accuracy were estimated. RESULTS: The relation between the CT scan findings and HPE reports was high. Though false positivity was noted more in the ethmoid sinuses, significant impact on tumor staging was noted with false positivity of the nasopharynx. Also, false positivity was noted with orbital wall/content extensions, resulting in unnecessary exenterations of the orbit. However, CT scan reliably predicted infratemporal fossa extension in the absence of trismus. False negativity was noted more often in soft palate, indicating the need of using MRI for delineation of tumor extension. Thus, we conclude that judicious use of CT scan in all cases and MRI in selected cases will translate into better tumor-free resections and improves survival.

Heavy metals testing in active pharmaceutical ingredients: an alternate approach.

The principle of the pharmacopoeial heavy metals test is detection and estimation of the metallic impurities colored by sulfide ion by comparison against lead standard. The test suffers from a loss of analytes upon ashing and from having varied responses for various metals. An inductively coupled plasma-optical emission spectroscopy (ICP-OES) for estimating 23 metals in active pharmaceutical ingredients is being proposed. The method covers the metals listed in USP, Ph. Eur and EMEA guidance on "Residues of Metal Catalysts or Metal Reagents".

"NCCT scan"--an alternative technique for Gorge carcinoma.

INTRODUCTION: Gorge carcinoma or carcinoma of esophagus is one of the most commonly occurring malignancies in developing countries. In these patients, dysphagia for liquids is one of the most common complaints, resulting in unwillingness of the patient to swallow contrast containing liquid. The objective of the study was to find an alternative technique to the currently existing techniques for evaluating esophageal carcinoma. MATERIALS AND METHODS: Twenty patients with endoscopically proved cases of esophageal cancer were examined with CT thorax using AIR (negative) as a contrast agent-negative contrast computed tomography scan. Only the mid- and lower third esophageal malignant cases were included in the study. Upper third esophageal malignancy and lesions causing complete obstruction were excluded from the study. All cases were scanned using single-slice Somatom-4 (Siemens). NECT scan was done after intravenous injection of Buscopan. A total of 450-600 ml of air is introduced through a 14G Ryle's tube, both manually and as a continuous flow. IV contrast is given simultaneously, and a CECT scan is done. Multiplanar reconstructions were done in all patients. RESULTS: Significant distension of the normal esophagus was noted. However, very minimal distension of the esophageal lumen was noted at the carcinomatous site--called the "streak sign" as air is seen as a thin streak within the narrowed lumen. In some cases, intraluminal polypoid growth could be seen. No significant complications were noted except for throat irritation. We conclude that usage of air as negative contrast in identifying carcinoma of mid- and lower third esophagus is safe, cost-effective, and feasible and can be used as an alternative technique in patients who are not readily willing to swallow liquid contrast.

Posterior mediastinal liposarcoma simulating a lung mass: an unusual case report.

Liposarcomas constitute approximately 15% of all sarcomas among the mesenchymal neoplasms. They usually arise in the lower extremities or in the retroperitoneum but have been reported in sites such as abdomen, vulva and buttocks. Primary mediastinal liposarcomas are rare with less than 100 cases reported worldwide so far. We present an interesting case of primary myxoid LPS of the posterior mediastinum with presenting complaints, imaging diagnosis and management with a review of the current literature.

Endoscopic ultrasound-guided trucut biopsy of the cyst wall for diagnosing cystic pancreatic tumors.

BACKGROUND & AIMS: Nonoperative methods for diagnosis of pancreas cysts often lack sufficient accuracy. Accurate diagnosis is needed to determine prognosis and guide clinical management. The aim of this study was to determine whether the tissue obtained by endoscopic ultrasound-guided trucut biopsy (EUS TCB) is sufficient for histologic diagnosis of cystic pancreatic tumors (CPTs). METHODS: EUS TCB was performed in patients with a suspected CPT. A dedicated gastrointestinal pathologist reviewed the core biopsies. The final diagnosis was based on clinical, laboratory, imaging, and biopsy findings, and resected specimens when available. RESULTS: EUS TCB was performed in 10 patients with a suspected CPT. Final diagnoses included serous cystadenoma (SCA, n=5), islet cell tumor (n=2), mixed seromucinous lesion (n=1), polycystic disease of the pancreas (n=1), and pseudocyst (n=1). EUS TCB was nondiagnostic in 3 of 10 patients. Among the other 7 patients, TCB diagnosed 4 SCAs, obviating the need for planned surgery in 3 patients. In the fourth patient with an SCA, the TCB result ruled out metastatic disease from locally recurrent lung cancer, allowing a narrowed radiation field. EUS TCB confirmed the need for surgery in 2 patients with an islet cell tumor. In 1 patient, EUS TCB findings were "partially" diagnostic, leading to previously unplanned surgery. CONCLUSIONS: This report establishes the capability and safety of EUS TCB to collect sufficient tissue for diagnosing CPTs. The results might help guide clinical management.

Endoscopic ultrasound for luminal malignancies.

Luminal gastrointestinal (GI) tract cancers are responsible for substantial morbidity and mortality. Since the first pairing of ultrasonography with endoscopy in 1980, technologic advances and the increased availability of trained endosonographers have propelled endoscopic ultrasonography (EUS) to the forefront of luminal GI cancer staging. In this article we discuss the role of EUS for evaluating luminal GI cancers.

EUS-guided trucut biopsy in establishing autoimmune pancreatitis as the cause of obstructive jaundice.

BACKGROUND: The diagnosis of autoimmune pancreatitis can be difficult and often requires a larger specimen than can be provided by FNA alone to determine if the tissue sample obtained with EUS trucut biopsy (TCB) is sufficient to allow adequate histologic review to establish the diagnosis of autoimmune pancreatitis. METHODS: EUS TCB was performed in patients presenting with obstructive jaundice who were suspected of having autoimmune pancreatitis based on their clinical, laboratory and imaging studies. The charts were retrospectively reviewed to determine the feasibility of TCB. RESULTS: Between August 2002 and June 2004, 3 patients with obstructive jaundice and suspected autoimmune pancreatitis (AIP) underwent EUS TCB. In each case, a diagnosis of pancreatic cancer also was considered, and surgical resection was the planned therapy before the patient underwent EUS TCB. Histologic review of the TCB specimens established the diagnosis of AIP in two patients and identified nonspecific changes of chronic pancreatitis in the third patient. EUS-guided FNA was performed in two of the 3 patients and failed to establish the diagnosis in either patient. Other than mild transient abdominal pain (n = 1), no complications were identified. CONCLUSIONS: This preliminary study suggests that EUS TCB can safely establish the diagnosis of AIP. Doing so helps guide management and may help to avoid unnecessary surgery. Prospective studies are needed to verify these findings and to more clearly define the role of EUS TCB in these patients.

Pancreatic mucinous cystic neoplasm defined by ovarian stroma: demographics, clinical features, and prevalence of cancer.

BACKGROUND & AIMS: Pancreatic mucin-producing cystic neoplasms are classified into 2 distinct entities: mucinous cystic neoplasm (MCN) and intraductal papillary mucinous neoplasm (IPMN). In previous studies, MCN often has been defined loosely and has not always been distinguished clearly from IPMN. Our aims were to determine the demographics, clinical features, and prevalence of invasive cancer in MCN defined by the presence of characteristic ovarian stroma. METHODS: By using the presence of ovarian stroma as a requisite criterion for diagnosis of MCN, a single pathologist, unaware of clinical information, identified 56 MCNs from 243 mucin-producing neoplasms resected at Mayo Clinic between 1986 and 2003. Medical records of the MCN patients were reviewed to obtain clinical and demographic data. RESULTS: Patients with MCN were almost exclusively (98%) women; we identified 1 man with a neoplasm containing ovarian stroma. The mean (+/-SD) age at resection was 48 +/- 15 years (84% < 60 y). Abdominal pain was the most common presenting symptom; 16% were asymptomatic. Most MCN (93%) were in the pancreatic body/tail region. Their median size was 5 cm (61% > or =5 cm). Histologically, 50 (89%) were adenomas, 2 (4%) had carcinoma-in-situ, and 4 (7%) had invasive cancer. None of the 22 MCNs <5 cm in size had invasive cancer. No patient with noninvasive disease had a recurrence after resection. CONCLUSIONS: MCN defined by ovarian stroma has a distinct demographic and clinical profile and a low prevalence of invasive cancer. These observations suggest that ovarian stroma should be used as the defining criterion for diagnosing MCN.