Risk factors associated with disease recurrence in patients with T4 staged Squamous Cell Carcinoma of the Oral Cavity treated with surgery and postoperative radiotherapy

Objective: To determine the association of clinical and pathological parameters on recurrence of treated stage T4squamous cell carcinoma of oral cavity patients managed with surgery followed by concomitant chemo and radiation therapy. Method: The retrospective, cohort study was conducted at Patel Hospital, Karachi, and comprised data of patients diagnosed with oral squamous cell carcinoma and admitted between January 1, 2014, and January 30, 2019. Patients of either gender aged 20-80 years who had a minimum follow-up of one year were included. Data was collected using the Head and Neck Cancer registry form and the medical record files. The subjects were also contacted by telephone when needed. The study end-points were disease-free survival and overall survival. Data was analysed using SPSS 21. Results: Out of the 83 patients, 65(78%) were male. The overall median(range) age was 46(20-80) years, and 43(52%) of them were aged 31-50 years. Overall, 15(18%) patients had positive margins and 48(58%) had proven cervical node metastasis on histopathology. Overall survival was 42.2% with the median(range) follow-up time was 14(9-21) months and 5-year disease-free survival was 45.8% with the median (range) follow-up time was 13(7-19). The factor that affected the final outcome was found to be the increasing nodal ratio (p=0.043). Conclusion: Among T4 oral squamous cell carcinoma patients treated with surgery and adjuvant therapy, the rate of disease recurrence was found to be high. Tumors with a high cervical nodal disease burden and/or margin involved were at substantially higher risk of recurrence. Key Words: Squamous cell carcinoma, Oral cancer, Recurrence, Survival.

To assess the aggressiveness of oral squamous cell carcinoma in the young population

Objectives

To assess the recurrence and disease-free survival in oral squamous cell carcinoma patients, and to compare them between two age groups.

METHODS

Data were extracted from Patel hospital cancer registry database of patients admitted from January 1st2008 to December 31st 2018 based on retrospective diagnosed with oral squamous cell carcinoma. Patient stratified in to two groups i.e. patients with less than or more than 40 years. Various etiological factors, staging, treatment, site of the tumor and recurrence and mortality were assessed.

RESULTS

Of the 450 patients, 124(27.5%) were in group A and 327(72.5%) were in group B. There were 101(81%) males in group A and 240(73.4%) males in group B. The overall mean age was 43.63±10.75 years (range: 22-70 years). The most common site of the tumour was cheek 232(51.5%). Recurrence of tumour was 45(36%) in group A and 120(37%) in group B (p=0.653). Overall mortality in group A was 67(54%) compared to 168(51%) in group B (p=0.811).

CONCLUSIONS

Mortality and disease recurrence in both age groups was almost the same. Cheek was the most common site of presentation.

Role of contrast enhanced computed tomography in assessing cervical lymph node metastases in oral cavity squamous cell carcinoma

OBJECTIVE

To evaluate the diagnostic accuracy of contrast-enhanced computed tomography scan in detecting cervical nodal metastasis in oral cavity squamous cell carcinoma.

METHODS

The retrospective cross-sectional study was conducted at Aga Khan University Hospital, Karachi, Pakistan. and comprised records from January 1, 2015, to October 31, 2016, of patients diagnosed with oral cavity squamous cell carcinoma and who underwent surgical resection of primary tumour along with neck dissection after having a contrast-enhanced computed tomography scan of head and neck. Diagnostic accuracy of the scans was calculated using final histopathology as the gold standard. All scans were reviewed by a consultant radiologist. Data was analysed using SPSS 23.

RESULTS

Of the 100 patients whose records were reviewed, 70(70%) were female, 55(55%) had buccal and 32(32%) had tongue cancer.. The scans had sensitivity 83%, specificity 61.7%, positive predictive value 70.9%, negative predictive value 76.3% and overall diagnostic accuracy 73%.

CONCLUSIONS

Computed tomography scan was found to be a useful tool for preoperative staging of oral cavity squamous cell carcinoma. However, due to low specificity and negative predictive value, elective neck dissection should still be done in a negative scan for cervical lymph node metastases.

Calcifying fibrous pseudotumour of maxilla: A rare entity mimicking malignancy: A case report

Occurrence of inflammatory pseudotumour in head and neck region or nose and paranasal sinuses is rare. However, when they do occur, they could be quite aggressive. Etiologically, they are believed to be reactive than neoplastic, and calcification may suggest end-stage. Their clinical presentation and radiologic features may resemble a malignancy. Grossly, they are not encapsulated, but multilobulated and can be circumscribed or infiltrative. Histologically, they constitute of bland spindle cells with scant cytoplasm and occasional mitotic figures. Scattered lymphocytic and plasma cell infiltrates with abundant dense hyalinized collagenous stroma and focal small calcifications are seen. Presence of atypia, DNA aneuploidy, and abnormal p53 expression may suggest malignant potential. Though not known to metastasize, they can lead to local complications, causing destruction of bone and surrounding tissues. Management is mainly by surgical excision though adjunct corticosteroids have been advocated. We report such a rare case of calcifying fibrous pseudotumour of maxilla.

Effects of bomb blast injury on the ears: The Aga Khan University Hospital experience

OBJECTIVE

To evaluate the frequency and effects of blast-related otologic injuries.

METHODS

his retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised charts of patients who were victims of bomb explosions between January 2011 and July 2013. Frequency and percentages were reported using cross tabulation with size of bomb, distance of person from blast and the presence of victim in open or closed space. Association of associated variables were also analysed.

RESULTS

Of the 100 patients, 81(81%) were men and 19(19%) were women. Besides, 68(68%) patients were aged <30 years. Also, 78(78%) subjects were exposed to < 80kg of explosives and 68(68%) were at a distance of>10m. Furthermore, 61(61%) patients were exposed to explosion in openspace. The prevalence of ear injuries was 21(21%). The odds of experiencing various symptoms of ears was high in those who were exposed to >80 kg of explosives (odds ratio: 3.38; 95% confidence interval, 1.16, 9.91). The odds of hearing loss in those who were within 10m was 8.62 (95% confidence interval: 2.72, 27.28) times than those who were >10 m from the site of explosion.

CONCLUSIONS

Otologic injuries were frequently associated with large blasts.

Effectiveness of plain X-ray in detection of fish and chicken bone foreign body in upper aerodigestive tract

OBJECTIVE

To assess the use of plain film radiology in the detection of fish and chicken bones in the upper aerodigestive tract.

METHODS

This retrospective chart review was conducted at the Aga Khan University Hospital, Karachi, and comprised medical charts of patients who had undergone oesophagoscopy for removal of fish and chicken bone from 1990 to 2015.SPSS 19 was used for data analysis.

RESULTS

Of the 24 patients, foreign body was detected on X-ray in 7(29.2%) and through fibre optic laryngoscopy in 13(54.2%).All the patients underwent surgical intervention for removal of the foreign body. Also, 19(79.2%) patients underwent direct laryngoscopy and 5(16.7%) required oesophagoscopy. The sensitivity with X-ray was 15% and specificity was zero. The sensitivity of fibre optic laryngoscopy in comparison to intra-operative findings was 65% and the specificity was 100%.

CONCLUSIONS

X-ray was not found to be an ideal modality to diagnose fish or chicken bone impaction in the upper aerodigestive tract.

Frequency of Sensorineural hearing loss in chronic suppurative otitis media

Chronic suppurative otitis media (CSOM) is defined as chronic otorrhea (i.e., lasting > 6-12 weeks) through a perforated tympanic membrane. It is generally associated with some degree of conductive hearing loss. However, recurrent ear infections due to perforated eardrum result in absorption of toxins and macromolecules into the cochlea leading to sensorineural hearing loss (SNHL). We planned to determine the frequency of sensorineural hearing loss in chronic suppurative otitis media. A descriptive cross-sectional study was conducted at Aga Kgan University Hospital, Karachi, from October 2013 to March 2014. Average threshold of speech frequencies was calculated via pure tone audiogram for both diseased and normal contralateral ear.A mean of >25db in diseased ear was labelled as positive case for SNHL. SNHL was reported in 64(52%) patients and the frequency was found to increase with increasing duration. Patients with CSOM should be counselled regarding the risk of developing SNHL if left untreated.

Is There Any Benefit of Drain Placement on Postoperative Complications in Patients Undergoing the Sistrunk Procedure?

Introduction Same-day, outpatient Sistrunk procedure is commonly performed to manage thyroglossal duct cyst anomalies and may lead to postoperative complications. Surgical drains are placed to prevent complications, but recent observations show no advantage and rather increased health care costs and patient discomfort. Objective The study evaluated if drain placement in the Sistrunk procedure offers any benefit on postoperative complications. Methods A retrospective analysis of patient records having undergone same-day, outpatient Sistrunk procedure from 2004 to 2014 was done. Of 58 (38 male and 20 female) patients included, 38 did not have drains placed and the remaining 20 had drains placed. Mean and median age of patients was 18.1 and 13.5 years, respectively. Postoperative complications of patients with drains versus those without drains were statistically analyzed. Results Overall, about 10% of patients had hematoma/seroma (H-S), with 6.9% of patients needing aspiration for H-S; 3.4% had wound infections; and 1.7% had pus formation. No statistically significant differences in Sistrunk-related complications between patient groups (with drain or without drain) were seen using Fisher exact (two-sided) test: H-S (p = 0.08); need for aspiration (p = 0.29); wound infection (p > 0.05); and pus formation (p = 0.35). Chi-square test also did not show any significant difference in the groups in terms of number of follow-ups. Conclusion Surgical placement of a drain in the Sistrunk procedure does not seem to offer any advantage in terms of reducing common postoperative complications. Same-day Sistrunk procedure without any drain placement may be a safer alternative without necessitating hospitalization. More studies with larger sample size are needed for further substantiation.

Histo-architectural alterations induced by Euclinostomum heterostomum (metacercariae) infected liver of Channa punctata (Bloch)

Present investigation was carried out to study the effect of digenetic trematode, Euclinostomum heretostomum on the histo-architecture of liver of Channa punctata. In case of mild infection, the metacercariae were found attached to the external surface of hepatic tissue. While in case of acute or chronic infection, the encysted metacercariae of Euclinostomum heterostomum were found deeply embedded in the entire hepatic tissue due to which liver appeared thin, compressed and pale with yellowish- black nodules of encysted metacercariae. A space occupying cavity is created by the metacercarial cysts due to which tissue appeared in the form of lumps. Histo-architectural alterations induced by parasite included degeneration, compression and loosening of hepatic tissue with enucleated and deshaped hepatocytes.

Seasonal variation in physicochemical parameters and heavy metals in water of Upper Lake of Bhopal

Heavy metal pollution of fresh water is the single most important environmental threat to the future. Upper Lake is a freshwater lake, which is the major source of drinking water in the city of Bhopal, the capital city of M.P., the central province of India, but due to anthropogenic activities this lake is being polluted. During the investigation heavy metals and physicochemical parameters were analyzed to determine the water quality seasonally in the year of 2006 and 2007. All the physicochemical parameters except DO (6.50-6.97 mg l⁻¹), Free CO₂ (0.8-1.6 mg l⁻¹) and BOD (5.47-6.85 mg l⁻¹) were below the prescribed limit as recommended by Bureau of Indian Standards (BIS) for drinking water standards. In case of heavy metals, Ni (0.173-0.253 mg l⁻¹) and Cr (0.047-0.087 mg l⁻¹) were found beyond the prescribed limits (0.02 and 0.05 mg l⁻¹, respectively), whereas Pb (0.057-0.087 mg l⁻¹), Cu (0.016-0.020 mg l⁻¹) and Hg (0.0006-0.0011 mg l⁻¹) were within the safe limit. This study reveals that water of upper lake is partially polluted with heavy metals. It is recommended that strict vigilance and constant monitoring are needed to maintain water quality of the lake, which is a major source of potable water for the Bhopal city.

Bioaccumulation of heavy metals in fish tissues of a freshwater lake of Bhopal

Contamination of heavy metals, namely, lead, cadmium, zinc, nickel, copper, chromium and mercury was evaluated in the samples of water and tissues of Labeo rohita and Ctenopharyngodon idella of Upper Lake of Bhopal collected during summer, rainy and winter seasons of 2005-2006. Different organs of the fishes accumulated varying quantities of different heavy metals. In L. rohita, accumulation of heavy metals was in the sequence liver>kidney>gills>muscles, and in C. idella, it was gills>liver>kidney>muscles. Zn was the highest accumulating metal in fish, whilst Hg was the lowest and was well corroborated with those of water. The values of heavy metals were so far well within the maximum permissible standard value of heavy metals for drinking water and for fish culture as prescribed by various national and international agencies.

A studies on chemical control of S. mansoni intermediate host

This study was conducted to screen different snail species to determine their susceptibility for different parasitic infections and also to determine LC50 and LC90 values. The screening of snail species infected with Schistosome parasite and mean number of cercariae shed by individual infected snail was 184+12. The experiment on relationship of snail size and dose of Niclosamide showed that juvenile snails were more susceptible to chemical when compared with adult snails. A series of seven experiments indicated that concentration of 0.067 and 0.109 mg L(-1) were required to kill 50 and 90% snails, respectively in an exposure period of 24 h and no death occurred in recovery period.

Observations on the histological alterations in various tissues of EUS affected fish, Channa striatus (Bloch)

Histopathological investigations have been made on the skin, liver, kidney and intestine of, (EUS) affected fish, Channa striatus and following anomalies have been observed. Varying degree of degeneration has been observed in the epidermis, dermis, hypodermis and underlying musculature. In all the cases, the skin lost the scales and epidermis completely at the site of infection. The dermis along with hypodermis showed the signs of necrosis. Necrosis also took place in subcutaneous layer underlying the hypodermis. Necrotization and formation of granulomas can clearly be seen in circular and longitudinal muscle layers. The liver exhibited the loosening of tissue and distension in cell bodies. While in case of kidney, shrinkage took place in all the components. Similarly, the intestinal villi got necrotised alongwith their constituent elements.

Haematological investigations on fishes infested with fungal growth

Considerable changes have been observed in the haematological parameters of Labeo rohita, Mystus cavasius, Nandus nandus and Puntius sarana infested with Aphanomyces sp., Saprolegnia parasitica, Achlya prolifera and Dictyuchus monosporus, respectively. Substantial decline have been observed in the number of erythrocytes and lymphocytes. The number of granulocytes and monocytes were noticed significantly increased. The amount of haemoglobin has also been decreased drastically in all the cases.

Role of bacteria in the epizootic ulcerative syndrome (EUS) of fishes

Bacteriological examination of certain water bodies and fishes carrying EUS was carried out. As a whole, 17 species of bacteria were isolated from the investigated water bodies and EUS affected fishes. The species of bacteria isolated from fishes are common to those isolated from water. Experimental infection trials conducted suggested that Aeromonas hydrophila in association with Pseudomonas fluorescens, may be playing the role of primary aetiological agent in producing EUS in fishes.

Pemphigus vulgaris in older adults

OBJECTIVE

Pemphigus vulgaris (PV) affects primarily middle-aged persons in North America. Conventional therapy suggests use of high doses of systemic corticosteroids and immunosuppressive agents. We have observed a group of older patients with PV and determined their clinical characteristics, treatment, and clinical course.

DESIGN, SETTING, AND PARTICIPANTS

Eighteen patients with PV, in whom the onset of the disease was at age 65 or older, were observed and followed at the New England Baptist Hospital in Boston, Massachusetts, between 1985 and 1992. We determined sex and race distribution, disease severity, clinical presentation, autoantibody levels, treatment, response to treatment, and clinical course in these patients.

RESULTS

Men and women were affected equally. All the patients were white, and 50% were Jewish. Extensive disease was observed in only 27.8%. The disease was localized in 44.4%; in eight patients (44.4%), the use of sublesional corticosteroid (SLS) injection alone produced satisfactory clinical response. In patients with severe disease, the maximum dose of 60 mg/day of prednisone was sufficient. Patients with moderate disease responded to 20 to 40 mg/day of prednisone. Immunosuppressive agents were used in only four patients. The patients were followed for 3 to 15 years (mean 5.2 years). None of them died of the disease or the complications of therapy. At the time we reported this experience, most of the patients were in clinical remission without any therapy.

CONCLUSIONS

Our observations suggest that prognosis for older patients with PV is favorable. In several older patients, PV was controlled by SLS or lower doses of systemic corticosteroids. Systemic agents should be used cautiously and judiciously, and supportive measures should be offered frequently and aggressively.

Infertility in women with pemphigus vulgaris and other autoimmune diseases

BACKGROUND

Pemphigus vulgaris (PV) is an autoimmune disease. Autoimmune diseases may adversely affect reproductive function and could result in infertility.

OBJECTIVE

Our purpose was to describe nine young women with PV and infertility.

METHODS

A retrospective study was performed. Clinical characteristics, immunopathologic features, treatment, clinical course, and long-term follow-up were determined.

RESULTS

Eight of nine patients were unable to become pregnant. One patient became pregnant during a period of remission. In eight of the nine patients, the cause of infertility was ovarian. Anti-sperm antibodies were present in two of the patients.

CONCLUSION

Some patients with PV may have infertility. No definitive conclusion about the frequency of infertility in these patients or its relation to PV can be drawn. However, these observations indirectly demonstrate that there may be important interactions between the immune and hormonal systems.

Heterotopic thyroid follicles in the accessory mesonephric lobes of Heteropneutes fossilis (Bloch)

The presence of heterotopic thyroid follicles is reported in the accessory mesonephric lobes of Heteropneustes fossilis. They are found rarely and singly, scattered in the substance of these lobes, in the early stages of development; but in the adult organ they occur in groups. There is no regular distribution and proper arrangement of these follicles. They are mainly located in close proximity to blood vessels and are considered to have migrated to their heterotopic positions along them. They show some signs of functional activity in the adult animal.