Assessment of Accuracy of Fine Needle Aspiration Cytology and Ultrasonography in Relation to Histopathology in Cases of Solitary Thyroid Nodule.

The thyroid gland is an endocrine gland situated in the lower part of front and the sides of the neck. Thyroid nodules are very common with estimated prevalence that ranges from 4% by palpation to 67% by Ultrasonography. The main purpose of our study was to detect cases of thyroid carcinoma preoperatively in patients with solitary thyroid nodules and subsequently advise surgery in these selected patients only, without missing any malignancy. The goal of the investigating modalities used was that they should detect maximum (ideally all) cases of carcinoma and minimize the number of patients who might end up with unnecessary surgery. The present study was to be undertaken for assessment of accuracy of FNAC & USG in relation to Histopathology in cases of solitary thyroid nodule (accuracy in terms of sensitivity, specificity, positive predictive value, negative predictive value). In our series of total 102 pateints, 90 patients were females (88.2%) and 12 cases were males (11.8%). The overall incidence of malignancy in solitary thyroid nodules is 15.68%. In our series the sensitivity and specificity of Fine needle aspiration cytology and Ultrasonography was 81.25% & 98.84% and 75% and 77.91% respectively. The closest method to ideal was fine needle aspiration cytology. However, a combination of techniques, rather than a single technique, give optimum results & avoid unnecessary surgery in a greater number of patients without missing any malignancy.

Diagnostic Efficacy of Thyrotropin to Thyroglobulin Ratio in Correlation with Histopathology of Euthyroid Patient Having Solitary Thyroid Nodule.

In patients with solitary thyroid nodules, the first course of action is to determine whether the nodule is benign or malignant. Many investigations are used to differentiate between benign and malignant nodules so as to avoid surgery in those who don't need it. Among these, FNAC and USG are commonly used in association with clinical features but there are drawbacks of each technique. The present study was undertaken to assess the diagnostic effectivity of thyrotropin (also known as TSH) to thyroglobulin ratio in correlation with histopathology in euthyroid patients having solitary thyroid nodule. This is a prospective study carried out on 48 euthyroid cases of solitary thyroid nodule. All patients subjected to FNAC, USG, thyrotropin and thyroglobulin assay. Then, they underwent surgery and histopathological examination (HPE) of the specimens done. Finally, the histopathology reports were correlated with the thyrotropin to thyroglobulin ratio in order to evaluate their sensitivity and specificity by statistical methods. The sensitivity and specificity of thyrotropin to thyroglobulin ratio was 100% and 100% respectively. All malignant lesions according to thyrotropin to thyroglobulin ratio were confirmed by histopathology indicating its excellence. Therefore, TSH to thyroglobulin ratio helps in planning the correct management and avoids second surgery. It was found that serum TSH:Tg is a safe, reliable and effective diagnostic modality with a high sensitivity and specificity and is the single best investigation for preoperative evaluation of solitary thyroid nodule to differentiate between benign and malignant nodules.

An Observational Study Depicting Role of p16 in Detecting Human Papilloma Virus in Oral and Oropharyngeal Cancer and Associated Factors.

The longstanding phrase, traditional risk factors like-smoking, tobacco and alcohol are the only causative agents of oral and oropharyngeal squamous cell carcinoma (SCC) is changing now. Etiological divergence is taking place which we have to know to reach upon an exact cause of the disease. Human papilloma virus (HPV) infection is a well-established cause of oral cancer. Escalating incidence of HPV associated cancer has a strong impact on its management. So, a concern clinician needs to get aware for it. Among various types of HPV, HPV-16 is more frequently associated with oral cancers. HPV detection will become a game changer in management of oral cancers. HPV infection and p16 protein expression has a strong and consistent correlation. Therefore, immunohistochemical analysis of p16 protein can be a surrogate biomarker in high risk groups. This hospital based prospective observational study recruited 180 subjects of oral and oropharyngeal SCC. We underwent immunohistochemical analysis of p16 in biopsy specimen of subjects and studied HPV status and associated environmental, clinical and behavioral factors. We observed 9.4% (17/180) incidence of p16 positivity with female predominance. Our observations showed that its prevalence was higher in urban patients who were non tobacco users, had sexually transmitted disease, early stage (T1-T2), poorly differentiated SCC with nodal metastasis. We conclude that keeping in mind HPV as a cause of oral and oropharyngeal SCC, p16 should be use as a biomarker for its detection in high risk cases.

A Study of Pulmonary Function Tests in Patients with Chronic Rhinosinusitis Following Endoscopic Sinus Surgery.

Chronic inflammatory disorders of the upper airways are extremely prevalent and they have a major impact on public health.To assess the change in pulmonary function tests in patients of chronic rhinosinusitis undergoing functional endoscopic sinus surgery pre operatively and post operatively.To evaluate the difference in mean of FEV1, FEV1%, FVC, FVC%, FEV1/FVC in patients of chronic rhinosinusitis undergoing functional endoscopic sinus surgery.Prospective observational study.From July 2019 to September 2020 in Department of ENT and Head & Neck surgery, SMS Medical College, Jaipur.There was a significant improvement in the mean FEV1, FEV1%, FVC, and FVC% values post-surgically (p < 0.05). In our study, there was also a significant improvement in the FEV1/FVC value at one month postoperatively, reflecting the effect of FESS on relieving the symptomatic lower airway obstruction.Our study concludes that following Functional Endoscopic Sinus Surgery there is significant improvement in pulmonary function tests reflecting the improvement of asymptomatic lower airway disease in cases of chronic rhinosinusitis.

Role of Vimentin and E-cadherin Expression in Premalignant and Malignant Lesions of Oral Cavity.

To determine the role of Vimentin and E-cadherin expression in oral premalignant and malignant lesions. 68 histopathologically confirmed cases of premalignant and malignant oral cavity lesions enrolled. Biopsy specimens were taken from lesion of all cases and subjected to immunohistochemical evaluation of expression of E-cadherin and Vimentin. We examined the relationships between the expression of these markers and specific clinicopathological features were analyzed. Out of 68 cases 28 showed high vimentin expression (3 + and 4 + grade) and 40 showed low vimentin expression (1 + and 2 + grade). 20 cases out of 68 presented with high E-cadherin expression (3 + and 4 +) and rest 48 with low expression (1 + and 2 +) of the same. Smoking and tobacco chewing reflected non-significant association with their expression. In this study all 28 patients (100%) with high vimentin expression had malignant lesions and 17 (60.7%) presented with metastatic lymph nodes Out of 20 patients with high E-cadherin expression 8(40.0%) had malignant lesions and 12 (60.0%) had pre malignant lesions and 4 (20%) showed nodal metastasis. As tumor stage (TNM) progresses, it showed increased vimentin and decreased E-cadherin expression and vice versa. We concluded that increased vimentin and decreased E-cadherin expression in oral cancers are associated with metastasis and disease progression in terms of upstaging of disease. We can use cellular expression of vimentin and E-cadherin for early diagnosis of disease.

Correlation of Preoperative High-resolution Computed Tomography Temporal Bone Findings with Intra-operative Findings in Various Ear Pathologies.

High resolution computed tomography (HRCT) is a tool which provide fine details of temporal bone and its associated pathologies which are of extreme use in making diagnosis, to evaluate extension of disease and most important to plan surgical approach. Aim of the present study was to correlate HRCT findings with operative findings in different ear pathologies. This observational, prospective study enrolled 70 patients of different ear pathologies required surgical intervention. They were subjected to HRCT temporal bone and its findings were correlated with surgical findings. Mean age of the study population was 20.3 ± 12.04 years with M: F = 1.12: 1. HRCT showed specificity and sensitivity of 100% and 92.31% respectively in detecting ossicular erosion. It was 100% sensitive and 98.51% specific in detecting LSCC erosion, 85.71% sensitive and 96.83% specific in detecting facial canal dehiscence, 100% sensitive and 98.11% specific in detecting scutum erosion, 75% sensitive and 96.97% specific to detect tegmen erosion, 100% sensitive and 97.01% specific in detecting sinus plate erosion, 100% sensitive and 95.38% specific in detecting high jugular bulb, sensitivity and specificity both are 100% in detecting labyrinthitis ossificans and 100% sensitive in detecting otosclerotic foci. HRCT findings showed a good association with operative findings in terms of sensitivity and specificity. Thus, HRCT is a acceptable tool to make diagnosis and to plan surgical approach.

Hearing Outcome in Ossiculoplasty With Autologous Incus and Teflon Prosthesis in Chronic Otitis Media: a Comparative Study.

To observe and compare the functional outcome in term of hearing gain in ossiculoplasty with autologous incus and Teflon made TORP/PORP in cases of chronic otitis media (COM) with ossicular disruption. 60 patients of COM between age of 11-50 years who had ossicular disruption were included in the study. They were divided into two groups of 30 patients/ group: group 1 included those patients who had mucosal COM and group 2 included those who had squamous COM. They were further subdivided into 3 subgroups each as per the ossiculoplasty material used. Pre-operative pure tone audiometry (PTA) was done. They all were followed-up at 3 months after surgery and at that time PTA was done. Pre-and post-operative hearing was compared and hearing improvement was calculated in term of air-bone gap (ABG). Out of 60 cases, 16 cases marked as failure of ossicular reconstruction as post-operative A-B gap was > 30 dB. Among these 16 cases, 7 were those patients whom ossiculoplasty was done using autologous incus and in rest 9 patients PORP/TORP was used. Success rate of ossiculoplasty using refashioned incus was 76.66% whereas Teflon TORP/PORP had success rate of 70.00%. We conclude that hearing improvement after ossiculoplasty with autologous incus is better as compare with that obtained by Teflon TORP/PORP. Also, it is a cost-effective method.

Spectrum of Neurological Outcomes in Diphtheria: A Case Series.

Diphtheria is an acute infectious disease caused by the exotoxin produced by Corynebacterium diphtheriae, a gram positive bacteria. It has propensity to affect mainly cardiac muscle and nervous system. To study the percentage, spectrum of patients with various neurological complications and the pattern of recovery in followed up confirmed cases of diphtheria. Single centre prospective analysis of neurological complications in diphtheria patients from June 2019 to September 2020 at SMS Medical College and hospital,Jaipur. In this study, 60 cases were included. Immunised cases were 60% (36 out of 60 cases) whereas unimmunised constituted the rest 40% (24 out of 60 cases). Neurological complications were observed in 15% of the cases (9 out of 60). Isolated palatal palsy was the most common complication (4 out of 9 cases, 44.44%), succeeded by lower limb LMN palsies (2 out of 9 cases, 22.22%) with unilateral facial nerve palsy, bilateral abductor palsy and paralytic ileus constituting the rest (1 out of 9 cases each, 11.11% each). Onset of complications ranged from 10 to 36 days whereas recovery was complete and without any residual sequelae between 60 to 240 days. Our study concluded that neurological complications form a sizeable portion of post diptheritic complications and carries good prognosis, hence timely diagnosis and differentiation from other neuropathies is a pre requisite for rational management and contact tracing.

Traditional and Coblation Tonsillectomy in Pediatrics Population: A Comparative Study.

Tonsillectomy is still surrounded by controversy, especially regarding choice of surgical technique. Despite numerous surgical techniques are present, post-operative pain remains significant postoperative morbidities. An ideal method would lessen complications and minimize operative time and costs. This is a randomized double blinded interventional study. We enrolled 70 subjects and divided into two groups of 35 subjects in each. One group underwent traditional tonsillectomy and another underwent coblation tonsillectomy. We compared operating time, intraoperative blood loss, post-operative pain, return to normal activities and diet and post-operative hemorrhage. Mean operating time in coblation group was 18.24 ± 5.37 min and in traditional group 30.04 ± 7.08 min. The mean blood loss in coblation tonsillectomy group was 82.79 ± 21.13 ml and in traditional tonsillectomy 150.4 ± 37.91 ml. The mean of post-operative pain score in coblation tonsillectomy group was 3.2 ± 1.47 and in traditional tonsillectomy group 6.11 ± 1.61. The mean day of regaining activity in coblation tonsillectomy group was 6.26 ± 0.92 days and in traditional tonsillectomy group 8.26 ± 1.09 days. Mean time by which patients of coblation tonsillectomy group regained their diet was 4.11 ± 0.87 days whereas in traditional tonsillectomy group it was 6.14 ± 1.14 days. There was no case observed with episode of primary or secondary hemorrhage. We conclude from this study that coblation tonsillectomy takes less operating time with less blood loss, also associated with less post-operative pain, less time taken to achieve normal diet and activities.

Spontaneous Esophageal Perforation in an Infant: A Rare Case.

Spontaneous perforation of the esophagus is an emergency that requires early diagnosis and management. It may be fatal and delay in treatment can cause an increase in morbidity and mortality. Despite of being very rare in infants, we have to be watchful whenever we encounter signs and symptoms related to it. Only 7 cases of spontaneous esophageal perforation in infants have been report in the literature to the best of our knowledge. Here we are reporting a rare case of spontaneous esophageal rupture in an infant.

Is It Wise to Wait for Ear to Become Dry in Indian Scenario?

Tympanoplasty is the standard and well-established procedure for closure of tympanic membrane perforations. Tympanoplasty in wet ear is still a topic of debate among ENT surgeons. This study discusses the balance between wait and watch policy and early intervention in wet ear. It also compares the rate of graft uptake and hearing improvement in Type I tympanoplasty in dry and wet ears. This is a hospital based, observational, descriptive and comparative study. Total 246 patients enrolled in the study. Two groups were created with 123 patients in each group. One included dry ears and another included wet ears. All patients had mucosal type of chronic otitis media. They all underwent Type I tympanoplasty. Graft uptake rate and hearing was compared between both groups. The overall success rate (graft uptake) was 91.06% (224). The success rate in dry ear group was 93.50% (115) and in wet ear group it was 88.62% (109). This study concluded that there is no added advantage of drying the ear rather the delay in treatment increases morbidity and drop outs in Indian scenario.

Is thyroid excision mandatory with laryngectomy in carcinoma larynx?

BACKGROUND: Advanced stage operable cancers of larynx are treated with total laryngectomy including thyroid resection in most of the cases, which may expose patient to hypothyroidism and hypoparathyroidism. The requirement of thyroidectomy during Total Laryngectomy is controversial. METHODS: A cross sectional observational study was set out to review preoperative clinical and radiological assessment; intraoperative and histopathological findings; and follow-up data to predict thyroid gland invasion in the setting of squamous cell carcinoma of the Larynx. RESULTS: 11 (16%) out of 69 patients had thyroid gland involvement on histopathological examination with mean age 63 years. Out of these 11 cases, 8 (72%) underwent primary total laryngectomy. 90% patients with thyroid gland involvement were male. 9 cases with thyroid gland involvement were staged as T4a preoperatively. CONCLUSION: Invasion of thyroid gland by laryngeal cancer is uncommon. Unnecessary hemithyroidectomies lead to hypothyroidism and hypoparathyroidism. The study points out the clear indications of thyroid excision in patients undergoing total laryngectomy. We can suggest that total thyroidectomy should be done with total laryngectomy in cases which have gross clinical, radiological or intraoperative thyroid gland involvement, subglottic extension and thyroid cartilage invasion. This can save the patients from the brunt of unnecessary morbid hypothyroidism and hypoparathyroidism.

Vitamin D: A Modulator of Allergic Rhinitis.

Allergic rhinitis is a topic of concern among clinicians. Despite of being treated in form of oral medicines, nasal drops and sprays several patients come back with complaint of no relief. This necessitates to review and focus on etiology and to find some other treatment regimen. Established relation of serum vitamin D level and various allergic conditions attracts us to use it as a therapeutic agent for allergic rhinitis. It is a case-control observational study recruited 80 subjects with 40 cases and 40 controls. There was drop out of two subjects among cases. Cases were supplement with oral vitamin D (cholecalciferol-1000 IU OD) and controls received no treatment. Serum vitamin D level, Total nasal symptom score (TNSS) and total eosinophilic count (TEC) were calculated at 0, 1 and 3 months and compared. Pre-treatment average serum vitamin D level of cases was 20.15 + 10.26 ng/ml and of control was 27.94 + 13.38 ng/ml. The TNSS score of cases was 7.43 + 1.87 and of controls was 5.00 + 1.52. TEC of cases was 546.15 + 113.39 and of controls was 313.33 + 125.08. Post-treatment serum vitamin D level of cases was 38.05 + 14.62 and of controls was 27.43 + 12.76. TNSS of cases was 3.53 + 0.68 and 4.43 + 1.17 in control group, TEC of cases was 68.13 + 38.95 and of controls was 197.03 + 123.36. This study concludes that vitamin D acts as disease modulator in allergic rhinitis In case of allergic rhinitis with vitamin D deficiency its supplementation gives symptomatic relief and also lowers down the values of TNSS and TEC.

Post-operative Sensorineural Hearing Loss After Middle Ear Surgery.

Chronic suppurative otitis media is managed by tympanomastoid surgery often requires mastoid drilling. Sometimes patients develop sensorineural hearing loss after middle ear surgery. Objective of the study was to compare pre and post operative bone conduction thresholds after middle ear surgeries. The study was conducted on 90 patients who had undergone middle ear surgeries, 30 patients of tympanoplasty (group I), modified intact canal wall mastoidectomy and tympanoplasty type-I (group II) and modified radical mastoidectomy (group III) each ware included. Demographic and clinical data were reviewed. Duration of surgery, ossicular and middle ear status and drilling time noted. Pre operative and post operative (after 3-4 months) bone conduction thresholds were compared statistically. A value of p < 0.05 was considered statistical significant. The average pre-operative hearing loss of study group was 43.78 ± 14.22 dB. Though postoperatively mean air conduction threshold improved to 36.07 ± 13.05 dB, six patients presented with deterioration of hearing. Mastoidectomy has been performed in all six. Post-operative worsening of bone conduction was seen in three patients (13.75-21.5 dB), one patient of group II and two patients of group III developed postoperative worsening of bone conduction thresholds. Significant hearing losses may occur after tympanomastoid surgery in few patients. While we are evaluating the results besides reporting average results such individual patient should be identified.