Prevalence and risk factors of post-operative nausea and vomiting in a tertiary-care hospital: A cross-sectional observational study.

Background: Post-operative nausea and vomiting (PONV) is an unpleasant and one of the most distressing symptoms for any patient undergoing surgery. The anaesthetist is usually blamed, despite evidence that PONV results from a variety of factors including patient characteristics, anaesthetic techniques, and the type of surgery and post-operative care. This study had been conducted to find out the current prevalence and to assess various risk factors for PONV in the Indian population. Methods: All patients above 18 years undergoing non-cardiac surgery under anaesthesia were selected from the daily operation theatre list by a systematic random sampling method. Koivuranta score was used to predict PONV in first 24 h post-operatively. Results: Prevalence of PONV in the study population was found to be 25.6%. There was association detected between female gender, non-smokers and occurrence of PONV (CI 95%, p ≤ 0.001, 0.005, respectively). PONV was seen to be more common in patients with history of PONV in prior surgeries, in patients who underwent surgery under general anaesthesia and in patients where opioids were used in the post-operative period (95% CI, p ≤ 0.001, 0.001 and 0.001 respectively). General, laparoscopic, abdominal, orthopaedic, obstetric, breast and urological surgeries showed a significant association with occurrence of PONV (95% CI, p ≤ 0.05). Conclusion: Inspite of use of antiemetics (single or dual) being given as part of the institutional protocol, the incidence of PONV was still high. There is a need to update our knowledge regarding newer antiemetics and their inclusion in PONV management guidelines. There is need for further research to study various other possible risk factors which may contribute to occurrence of PONV.

Probabilistic Reconstruction of Austenite Microstructure from Electron Backscatter Diffraction Observations of Martensite.

The fine microstructure resulting from the martensitic transformation drives many of the desired mechanical properties for quench-and-temper steels. The scale of martensite features correlates with austenite grain size, such that finer austenite grains produce finer martensitic structures. Measuring prior austenite grain (PAG) size from observations of the hierarchical martensitic structure using etch-based techniques remains challenging, especially for fine-grained specimens with low C and P content. This has driven an interest in our field in reconstructing prior austenite microstructure from electron backscatter diffraction (EBSD) data collected on tempered martensite. However, reliably reconstructing the data is not straightforward because (1) up to 24 variants can theoretically be observed from a single PAG; (2) the shear-induced plasticity that arises from martensite formation produces significant scatter in the pole figure; (3) there is inherent noise in Hough-indexed EBSD data; (4) annealing twins exist within many PAGs, producing martensite variants of similar orientations when compared with the parent grains; and (5) variation in austenite orientation can occur across a single PAG. To the author's knowledge, the majority of reconstruction algorithms published to date utilize either point-to-point or flood-fill approaches, which can produce artifacts due to the relatively high probability of adjacent EBSD observations falling within any reasonable tolerance angle with 24 variants in a parent and four annealing twin orientations. Therefore, we propose a probabilistic austenite reconstruction technique based on a clustering algorithm known as graph cutting. We demonstrate its application to steels and a binary ferrous alloy, then validate the results against chemical etching and retained austenite orientations. The graph cutting technique utilizes the misorientation distribution of martensitic variants and the potential austenite orientations for each observation, as estimated via Bayesian inference of the experimental orientation relationship and its scatter. It is found that this technique produces accurate reconstructions with identification of annealing twins in the PAGs, even in the presence of a large fraction of poorly indexed data points.

Smartphone-Based Human Sitting Behaviors Recognition Using Inertial Sensor.

At present, people spend most of their time in passive rather than active mode. Sitting with computers for a long time may lead to unhealthy conditions like shoulder pain, numbness, headache, etc. To overcome this problem, human posture should be changed for particular intervals of time. This paper deals with using an inertial sensor built in the smartphone and can be used to overcome the unhealthy human sitting behaviors (HSBs) of the office worker. To monitor, six volunteers are considered within the age band of 26 ± 3 years, out of which four were male and two were female. Here, the inertial sensor is attached to the rear upper trunk of the body, and a dataset is generated for five different activities performed by the subjects while sitting in the chair in the office. Correlation-based feature selection (CFS) technique and particle swarm optimization (PSO) methods are jointly used to select feature vectors. The optimized features are fed to machine learning supervised classifiers such as naive Bayes, SVM, and KNN for recognition. Finally, the SVM classifier achieved 99.90% overall accuracy for different human sitting behaviors using an accelerometer, gyroscope, and magnetometer sensors.

Effect of confinement on water properties in super-hydrophilic pores using MD simulations with the mW model.

CONTEXT: We explore the influence of strongly hydrophilic confinement on various properties of water, such as density, enthalpy, potential energy, radial distribution function, entropy, specific heat capacity, structural dynamics, and transition temperatures (freezing and melting temperatures), using monatomic water (mW) model. The properties of water are found to be dependent on confinement and the wall-fluid surface interaction. Hysteresis loops are observed for density, enthalpy, potential energy, and entropy around the transition temperatures, while the size of hysteresis loops varies with confinement and surface interaction. In smaller pore sizes (H ≤ 20), the solid phase displays a higher density compared to the liquid phase, which is unconventional behavior compared to bulk water systems due to the pronounced hydrophilic properties of the confinement surface. Specific heat capacity exhibits more oscillations in the confined system compared to bulk water, stemming from uneven enthalpy differences across equal temperature intervals. During phase transformation in both heating and quenching processes, there is an abrupt change observed in specific heat capacity. Confinement exerts a notable impact on entropy in the solid phase, but its influence is negligible in the liquid phase. At lower pore sizes (H < 25 Å), there is more fluctuation in freezing temperature for all wall-fluid interactions, which diminishes beyond pore sizes of H > 25 Å. Similarly, more oscillatory behavior is observed in melting temperatures at lower pore sizes (H < 40 Å), which diminishes at higher pore sizes (H > 40 Å). During the quenching process, a sudden jump in the in-plane orientational and tetrahedral order parameters indicates the formation of an ordered phase, specifically a diamond crystalline structure. The percentages of different crystalline structures (cubic diamond, hexagonal diamond, and 2D hexagonal) vary with both the confinement size and the wall-fluid interaction strength. METHODS: Cooling and heating simulations are conducted with the mW water model using LAMMPS for different nanoscale confinement separation sizes ranging from 8.5 to 70 Å within the temperature range of 100-350 K. The water is modeled using two-body and three-body interaction potential (Stillinger-Weber potential) and the confinement is introduced using LJ 9-3 water-wall interaction potential. Entropy is calculated using RDF data obtained from the simulation experiments for each temperature point with increments or decrements of 2.5 K. The transition temperatures are estimated using the specific heat capacity analysis.

Nasolabial Flap: Versatile Flap for Basal Cell Carcinoma Nose.

Nasolabial flap is very versatile flap for the lesion of basal cell carcinoma of nose. It is preferred choice for the closure of surgical defect of nose after removing the lesion of basal cell carcinoma. This flap has very good vascularity and scar is almost invisible. The objective of this study to evaluate the suitability of nasolabial flap for the basal cell carcinoma, the survival of the flap, cosmetic appearance of the patient after the surgery and patient satisfaction. This is the case study of ten cases of basal cell carcinoma of the nose. The skin lesion was at the nasal tip, dorsum and the side of the dorsum. All the surgeries were performed by the same and first author of the article at the department of Otorhinolaryngology Sir T General Hospital Bhavnagar Gujarat. The patient age ranged from 5th to 6th decades of life. All the patients were from the coastal region of Saurashtra Gujarat. All the surgery was performed as single stage surgery. The defatting of the flap was done in all cases to match with the texture of skin of nose. The biopsy was performed in all the cases before the surgery to confirm our clinical diagnosis. The underlying cartilage was removed in all the cases to prevent the recurrence and was sent separately for the frozen and histopathology examination. The nasolabial flap survived in all the ten cases. The color and the texture of the flap matched perfectly with the adjoining skin color of nose. The scar mark of the cheek side malar flap was almost invisible. There was no trap-door deformity observed and there was good aesthetic outcome. The nasolabial flap is very reliable and versatile flap for the basal cell carcinoma sugary of nose. It can reach to almost to the all area of nose including tip of the nose. Its single stage surgery with very good aesthetic results.

Management of Maxillofacial Trauma in Road Traffic Accident (RTA) at Tertiary Care Center.

Road traffic accidents (RTA) are the major cause of maxillofacial injuries (MFIs) in developing countries (Akama et al. 2007). Road traffic accidents were reported to be the 9th most common cause of death and morbidity in the world and are expected to rise to 3rd position by 2020 (Peden et al. 2002). Maxillofacial injuries remain a serious clinical problem because of the involvement of complex anatomic region. Facial fractures occur most commonly in males in the third decade of life (Motamedi et al. 2014). The goal of treatment in facial fractures is to achieve anatomic reduction and restore function while increasing patient comfort and making postoperative care easier (Lachner et al. 1991). The aim of the study was to evaluate the cases of Maxillofacial injuries with the existing literature on its different presentation and management. An observational study was done from the patients of RTA with Maxillofacial injuries in ENT department and trauma centre of Sir T General hospital and Government Medical College, Bhavnagar for a period of 2 year. A total of 315 patients were included. Males are more commonly affected than females. The main etiological factor for RTA was motorcycle accidents. The trend of MFIs especially due to MCAs was on the rise after the age of 20 year. Anatomically the lower 1/3 section of the face was the most affected. Mandibular fractures were most common isolated fracture in MFIs. Open reduction and internal fixation (ORIF) by plating and screw was the treatment of choice for displaced, comminuted and multiple fractures of face. Facial trauma remains a major source of injury in all parts of the world. Its management involves many disciplines in the hospital setting, but knowledge of occlusion, the masticatory apparatus and anatomy is important for the best outcomes. This study was an analysis of demographic variables and outcome of the management adopted in patients presented to our department.

Bedside Tracheostomy: Our Experience in a Tertiary Care Hospital.

Tracheostomy is the creation of a stoma at the surface of skin, which leads into trachea. In the critically ill patients, it is one of the most frequently done procedure especially in intensive care unit (ICU) for those requiring prolonged mechanical ventilation. About 24% of all patients in ICU need tracheostomy (Esteban et al. in Am J Respir Crit Care Med 161:1450-1458, 2000). Historically it had a high complication rate and so many authors suggested that it should be done only in operating room (Dayal and Masri in Laryngoscope 96:5862, 1986). A standardized procedure to reduce complications was described by Jackson (Laryngoscope 19:285-290, 1909). The aim of the study is to observe and analyze the outcome of bedside open tracheostomy, in relation to its safety, complications and simplicity. Study consists of 200 patients who underwent bedside tracheostomies in a tertiary care center from 2014 to 2017 in medical/surgical/paediatric ICU's. All the procedures followed a standard protocol. In all the surgeries, two E.N.T. surgeons were scrubbed and did the procedure, assisted by two ICU nurses. One anesthetist who administered sedation and monitored the patient. If coagulation disturbances were present in elective case then they were corrected prior to the procedure. We all want the latest, safest, simplest and cheapest available technique in medical practice. Bedside tracheostomy is one such procedure. It is better than tracheostomy in operating room for patients who need prolonged mechanical ventilation in ICU as it eliminates the need of patient transport to OR and its associated complications and also minimizing cost. Training programs need to be provided to the assisting staff for better procedural outcome.

Post-Thyroidectomy Hypocalcemia: Clinical Study at Tertiary Care Center.

A recent review by the American association of clinical Endocrinologist (AACE) and American College of Endocrinology discussed definations and management of post-surgical hypocalcemia. In term of post-surgical hypocalcemia a total serum calcium of less than 8.5 mg/Dl(2.125 mmol/L) or ionised calcium less than 1.15 mmol/L were considered as cut off levels. The aim of the study is to evaluate & compare 30 operated cases of thyroid surgery based on its gender, age distribution, pre-operative indication & nature of surgery, post-thyroidectomy hypocalcemia. This prospective study was conducted in the Department of Otorhinolaryngology, head, neck surgery department sir T hospital, and government medical college Bhavnagar. All patients undergoing thyroidectomy surgeries were included in the study. Data collected from the patients undergoing thyroidectomise by meticulous history taking, careful clinical examination, appropriate radiological, haematological investigations including serum calcium and serum albumin, operative findings and follow-up of the cases was done after surgery for post- in association with nature of thyroid surgery. Post-thyroidectomy transient hypocalcemia is a frequent complication which can be prevented with pre-operative preparation of patients with extreme caution and pre-operative meticulous dissection, prompt identification of parathyroids and post-operative frequent monitoring of serum calcium and early treatment can prevent significant morbidity. operative hypocalcemia. The study was conducted to know the incidence of hypocalcemia after thyroid surgery.

An open label, active controlled, multicentric clinical trial to assess the efficacy and safety of fluticasone furoate nasal spray in adult Indian patients suffering from allergic rhinitis.

BACKGROUND: Allergic rhinitis is a common upper respiratory tract inflammation associated with a significant morbidity in all the age groups. Fluticasone furoate is a new potent topical glucocorticoid for the treatment of allergic rhinitis. OBJECTIVE: To compare efficacy and safety of fluticasone furoate (FF) nasal spray 110 microg/day with fluticasone propionate (FP) nasal spray 200 microg/day for the relief of symptoms of allergic rhinitis in adult Indian patients. METHODS: Clinically symptomatic patients (n=220) with allergic rhinitis received treatment with FF or FP for 2 weeks in this comparative, open label, multicentric, clinical trial. Nasal symptoms (nasal congestion, rhinorrhea, nasal itching, and sneezing) and ocular symptoms (itching/burning eyes, tearing/watering eyes, and eye redness) were recorded on a 4-point categoric scale by the patients. The efficacy was assessed by the change in nasal and ocular symptom scores as their subtotals (Total Nasal Symptom Score and Total Ocular Symptom Score) and grand total (Total Symptom Score). RESULTS: FF produced significantly better improvement in Total Symptom Score (-10.4 +/- 3.2 vs. -8.9 +/- 3.5, p<0.005) and Total Nasal Symptom Score (-7.3 +/- 2.2 vs. -6.2 +/- 2.6, p<0.005) as compared to FP. Also a significantly larger percentage of patients achieved complete symptomatic relief with FF (45.3% vs. 31.4%, p<0.05). FF was also better tolerated than FP. CONCLUSION: FF nasal spray is significantly more effective and better tolerated than FP nasal spray for the treatment of allergic rhinitis in adult Indian patients.

Management of Mandible Fracture by Plating and Wiring: An Otolaryngologist Perspective at Teritiary Care Center.

The facial area is one of the most frequently injured parts of the body (Abiose in Br J Oral Maxillofac Surg 24(1):319, 1986; Adi et al. in Br J Oral Maxillofac Surg 28(3):1949, 1990; Allan and Daly in Int J Oral Maxillofac Surg 19(5):26871, 1990), and the mandible is one of the most commonly fractured maxillofacial bones (1990; Azevedo et al. in J Trauma 45(6):10847, 1998; Bremerich et al. in Acta Stomatol Belg 93:511, 1996). Mandible is the only mobile bone of the skeleton, and hence vulnerable to fracture. This is a retrospective study of 50 mandibular fracture cases managed at the Department of ENT, Govt. Medical College Bhavnagar during the 2 years period from 2014 to 2016. Maximum subjects were in age group 21-30 years with a male preponderance. Road traffic accident is the main cause followed by falls and assault. Symphysis is the most common site of Mandibular fracture. Mandible fracture is a common entity in Road traffic accidents. Multiple fractures are seen in 40% of mandibular fracture cases. The results were equally good in patients requiring only MMF (Maxillo Mandibular Fixation) and inpatients requiring MMF and Plating, during the follow up up to 8 weeks. Physiotherapy was advised for all the post op patients after 2 months.

High altitude area - A risk factor for gastric perforation? : A case series.

INTRODUCTION: This is an original case series on soldiers evacuated from HAA(High Altitude Area) over last one year(Sept 2017-Aug 2018), of which 100% cases were found to have gastric antrum perforation. This is a deviation from the usual trend that is being noted in Indian subcontinent where duodenal perforations are commonest. DISCUSSION: High altitude associated dyspepsia is a common phenomenon and some studies done in high altitude population have recorded high incidence of antral gastritis and mucosal atrophy on histo-pathological evaluation. This is also supported by high incidence of H. pylori infection. The presence of atrophic gastric mucosa associated with antral gastritis, when exposed to hypobaric hypoxemic conditions faced by soldiers posted to heights above 15,000 ft, may leads to increased intra-luminal pressure and ischemia which probably predisposes individuals for gastric antrum perforations. CONCLUSION: This is a relatively untouched topic as we have not found studies onhigh altitude related gastric perforations and probably this is the first case series of its kind. The acknowledgement of this phenomenon may pave way for further studies for defining the role of high altitude in gastric perforations.

Choanal Atresia: Birth Without Breath.

Bilateral Choanal atresia is a medical emergency. Corrective surgery is the mainstay of the treatment. Hegar's dilator was used in all cases to break the bony/membranous atretic plate. The 22 cases of choanal atresia all operated by the first author were included in this study. Eight cases were 1-5 year old with bilateral choanal atresia and all required immediate surgery as they had repeated attacks of respiratory distress and cycle of cyanosis. Eight cases were of CHARGE Syndrome. All the cases were operated under general anaesthesia. Hegar's dilators were used and nasal stents were placed in all cases. Although complete nasal patency was achieved by surgery, in 8 cases, neonates could not survive due to the CHARGE Syndrome. The mortality was unrelated to the surgery. The 14 cases which were not related to CHARGE Syndroma had a good postoperative recovery. 3 cases were above 15 years old with unilateral complete bony/membranous choanal atresia and they presented with continuos nasal discharge. Hegar's dilators are a safe and simple method of surgery for choanal atresia. Nasal stenting is mandatory to prevent restenosis.

Tutoplast-processed fascia lata for dorsal augmentation in rhinoplasty.

OBJECTIVE: Tutoplast-processed fascia lata (TPFL) is a commercially available homograft, which has been successfully used as human graft tissue for physical support procedures. The present report evaluates the use of TPFL in rhinoplasty. STUDY DESIGN AND SETTING: The study involved a retrospective analysis of rhinoplasty cases using TPFL. The study population consisted of 69 patients (52 male and 17 female) and a minimum follow-up of 12 months. RESULTS: TPFL was used as a smoothening graft after correction of deviated and hump noses, as a major dorsal contouring graft for saddle or flat noses, and in secondary rhinoplasty following silicone implant complications. TPFL alone was used in 41 cases and in combination with other material in 28 cases. The only complication was major resorption in three cases, with two being secondary rhinoplasty patients. CONCLUSION: TPFL alone or in combination with other materials can be used as a dorsal augmentation material in rhinoplasty. TPFL was particularly useful for correction of dorsal irregularities and in cases requiring a minimal amount of augmentation.

Rigid Bronchoscopy in Pediatric Patients.

Aspiration of foreign-bodies remains a major life-threatening situation in children and have always been a source of interest and confusion to otolaryngologists due to their varied presentations. These conditions if not promptly diagnosed and managed can prove to be fatal, but the current mortality is only one percent compared to pre bronchoscopy era (Rothman and Boeckman in Ann Otol Rhinol Laryngol 89:434-436, 1980). Peak incidence of this condition is in early childhood due to child's habit of putting small objects in mouth to determine their taste and texture and chew while teething. This is a study conducted retrospectively from 2012 to 2017 in a teritiary care center. It includes a total of 70 cases of foreign body in airway who underwent rigid bronchoscopy under general anaesthesia. The patients were all in paediatric age group but mostly between 6 months to 3 years. The youngest patient was 3 months old and the oldest 12 years old. Male children (70%, n = 49) were more common than female children (30%, n = 21) with a male to female ratio of 2.33:1. A definite history of foreign body aspiration was given in only 70% cases, but the most common symptom were cough (100%) and breathlessness (80%). Organic foreign bodies (76.36%, n = 42) were more common when compared to inorganic foreign bodies. Foreign body most commonly impacted in Right main bronchus (49.09%, n = 27) followed by Left main bronchus (31.42%) and lastly the trachea (19.49%). Even though the mortality in patients of foreign body aspiration is low, it is essential to have proper cooperation between the otolaryngologists, paediatrician and the radiologist for rapid diagnosis and prompt management. It is advised to have a second look to check all the bronchopulmonary segments. Life saving steps are Prompt referral, early diagnosis and vigilant management.

A study of applications of rigid bronchoscopy in pediatric patients.

The aim of the study was to analyse the various indications of rigid bronchoscopy in paediatric patient, the common clinical symptoms, radiological findings, and outcomes of the procedure. A retrospective study was conducted at ENT Department at M. P. Shah Govt Medical College, Jamnagar, and Gujarat, India from 2010 to 2012. Total 50 cases of pediatric age group less than 12 years of age on whom rigid bronchoscopy was performed were included in this study. The diagnosis was based on clinical history, thorough clinical examination and radiological assessment. The total duration of the study was 3 years which included 50 Pediatric cases, males (76 %) were more common as compared to females (24 %), the most common age group which underwent the bronchoscopy was 1-3 years of age. Most common indication for doing rigid bronchoscopy was foreign body aspiration in 84 % of cases (n = 42) followed by other indications like Subglottic stenosis (6 %), Mucous Plugs (4 %) and Bronchoalveolar lavage (4 %). Rigid bronchoscopy has been a saviour and an essential part of standard medical practices for both Therapeutic and Diagnostic purposes. Proper history taking is an cardinal requirement before the procedure, and it is always better to rely on clinical findings rather than radiological findings. It is sensible to perform a Check Bronchoscopy in all cases to revisualise key areas and avoid missing any abnormality or foreign body.

Choanal Atresia: Surgical Management by Hegar's Dilators.

Choanal atresia is one of the more commonly observed congenital abnormalities of the nose. The condition is predominantly found in females with a M:F ratio of 1:2. 65-75 % of patients with choanal atresia are unilateral, and the rest are bilateral. About 50 % of the cases are associated with other congenital anomalies, the most common being coloboma, Heart disease, choanal atresia, mental and growth retardation, genital hypoplasia, ear deformities syndrome. The embryonic origin of choanal atresia is due to persistent bucco-pharyngeal or naso-buccal membrane. Our study was a retrospective study of 14 cases of choanal atresia. All the cases were operated by the first author. Each patient was investigated in detail and recorded by stratifying in sex of patient, age of presentation, type and site of atresia, and associated other congenital anomalies. Patient were operated under general anesthesia and Hegar's dilators were used to perforate the atretic plate as Hegar's dilators are believed to have ideal curvature with respect to the sloping contour of the nasal floor. Out of the total 14 cases, 9 (64 %, n = 14) cases were male and 5 (36 %, n = 14) females. The age variations varied from youngest of 3 days to the oldest 31 year old female. Stents were kept for a period of 6-8 weeks and regular follow up nasal endoscopy was done weekly for suctioning and visualizing the size of the airway. There are five different surgical approaches that have been described for surgical treatment of choanal atresia: (1) trans-nasal, (2) trans-palatal, (3) trans-septal, (4) trans-antral and (5) sublabial-transnasal. In our study M:F ratio was 1.8:1 which is comparable Gosepath et al. (Rhinology 45:158-163, 2007) (2:1). In our study bilateral atresia was seen in 43 % (6, n = 14) and unilateral in 57 % (8, n = 14) which is comparable to Newman et al. (44 % bilateral cases, n = 43). Amicable and prompt referral to the ENT surgeon can be of immense value so as to buy adequate time for the surgeon to decide and act as per the patient's clinical and radiological findings. Hegar's dilator is passed along the floor of the nose, pushed against the septum so as to avoid penetrating the basal sphenoid.

Auricular reconstruction - Our experience at marienhospital stuttgart, Germany.

The aim of the paper is to report our experience of 60 ear reconstructions to correct the microtia with surgical technique. Autogenous rib cartilage was used to reconstruct the affected ear. Cartilage resorption was found in 10% of the cases, distortion and fusion of pinna in 20% of the cases and infection was found around 8% of the cases. Most of the patients were satisfied with the final result.

Extended anterior nasal packing in juvenile nasopharyngeal angiofibroma.

This is the case study of 16 patients in which postoperatively after complete removal of tumors, the bleeding did not stop with anterior and posterior nasal packing. In all those cases extended anterior nasal pack was applied during the surgery after the complete removal of tumor and bleeding stopped effectively.

Foreign body in tracheobronchial tree.

Foreign body inhalation into the tracheobronchial tree can prove to be a life threatening unless timely intervened and appropriate steps are being taken towards its management [1]. A review of 32 cases was done at MP Shah Medical College Jamnagar over a period of 2 years. Children were most susceptible to aspiration of foreign bodies. All the cases were selected on the basis of detailed clinical history, clinical features, and radiological findings. The cases which had a strong index of suspicion without any positive clinical history were also subjected to rigid bronchoscopy under general anesthesia. Maximum number of cases was in the age group of 1 to 3 years (62.5%). The minimum age group ranging from 6 months to maximum 8 years. The time of presentation of the patients varied from within 24 hours to upto 6 months. Only four patients presented within 24 hours. The maximum presenting period was within 1 week. Organic foreign bodies were most common presentation (groundnut). Other foreign bodies were grains, seeds, ball pen cap, stones and slate pencil. Definite history of inhalation was available only in 19 cases with symptoms of choking, breathlessness, cough and recurrent upper respiratory tract infection. Right main bronchus was found to be most common site of impaction (52%) followed by left main bronchus (32%) and tracheal foreign body (16%).

Juvenile nasopharyngeal angiofibroma-our experience at a referral hospital.

Nasopharyngeal angiofibroma is a rare, highly vascular locally invasive tumor with a strong tendency to bleed. It usually occurs in young adolescent males. This is a retrospective study of 53 patients with nasopharyngeal angiofibroma. All the cases were treated surgically by different conventional approaches depending upon the extent of the mass. Transpalatal approach was used in 32 cases, lateral rhinotomy in 13 cases and a combination of transpalatine + lateral rhinotomy + caldwel-luc in 8 cases. There is no recurrence in 49 cases till date. However, recurrence was noted in four cases within six months. Three out of four patients with recurrence had to undergo repeat surgery for the removal of angiofibroma within six months while the remaining one was referred to radiotherapy as the mass was invading the cavernous sinus. The various clinical presentation and treatment modalities are discussed.