Tracheostomy in Severe Bronchopulmonary Dysplasia-How to Decide in the Absence of Evidence.

Infants with the most severe forms of bronchopulmonary dysplasia (BPD) may require long-term invasive positive pressure ventilation for survival, therefore necessitating tracheostomy. Although life-saving, tracheostomy has also been associated with high mortality, postoperative complications, high readmission rates, neurodevelopmental impairment, and significant caregiver burden, making it a highly complex and challenging decision. However, for some infants tracheostomy may be necessary for survival and the only way to facilitate a timely and safe transition home. The specific indications for tracheostomy and the timing of the procedure in infants with severe BPD are currently unknown. Hence, centers and clinicians display broad variations in practice with regard to tracheostomy, which presents barriers to designing evidence-generating studies and establishing a consensus approach. As the incidence of severe BPD continues to rise, the question remains, how do we decide on tracheostomy to provide optimal outcomes for these patients?

Epithelial Myoepithelial Carcinoma Masquerading as Simple Parotid Cyst in a Middle Aged Male.

Epithelial-Myoepithelial Carcinoma (EMC) is a very rarely seen biphasic tumour typically seen in older females and constitutes 0.5-1% of all salivary gland neoplasms. The parotid gland is most often involved and occasionally there may be involvement of submandibular and minor salivary glands. Clinical picture often reveals benign nature of the disease. Computed tomography (CT) and magnetic resonance appearances are non-specific and the cytological diagnosis may be challenging, thus more accurate diagnosis can only be made by histological and immunohistochemical study. There is no consensus regarding the optimal treatment of this neoplasm, largely due to its rarity. Wide surgical excision with a clear margin is the treatment of choice because of the tumour's tendency to infiltrate locally. Adjuvant radiotherapy is often required in cases of large primary tumours and positive surgical margins. The tumour may commonly recur locally after resection in 30-50% of cases. We herein present an unusual case of a 46-year-old male who presented with cystic swelling of left parotid gland and diagnosed as EMC on histopathology and immunohistochemical examination. The patient was treated with surgical resection followed by post-operative radiotherapy.