The aging larynx: An anatomical perspective

There has been a striking increase in the geriatric population worldwide over the last few decades. As the aging process continues to alter functioning of all body systems, the human voice is also significantly affected. The senile voice is characterized by its changes in pitch, hoarseness, tremulousness, and breathiness with reduced harmonics and intensity. Such phonatory changes in the elderly may hinder effective communication, thus bringing down their confidence levels and impairing their quality of life. These characteristic features that distinguish the senile voice from younger speakers are accompanied by age?related changes in the organ of phonation, the larynx. The summative morphological and structural changes occurring in the elderly larynx have been referred to as “Presbylarynx.” The present review article is an attempt by the authors to explore the various anatomical age-related changes occurring in the larynx that may be responsible for altered vocal function in the elderly. An improved understanding of the anatomical basis of the aged voice can give further directions into the management of vocal disorders and improved speech performance in the elderly.

A comparative analysis between Mannheim peritonitis score and acute physiological and chronic health evaluation II score in predicting prognosis of patients of perforation peritonitis

Background: The early assessment and recognition of peritonitis patient is required in surgical emergency. Various scoring system have been designed successfully to assess the prognosis and outcome of peritonitis. The present study was carried out with an aim to evaluate the usefulness and severity of Mannheim peritonitis (MPI) score in comparison to acute physiological and chronic health evaluation II (APACHE II) scoring system for prediction of the outcome in patients with perforation peritonitis and thus decision making in perforation peritonitis.Methods: A prospective observational study was carried out at Department of Surgery, King George’s Medical University (KGMU), Lucknow for a period of one year from July 2018 to June 2019. A total of 100 patients were enrolled in the study.Results: Majority of patients were males compared to females. Maximum number of patients (40%) was aged 51-60 years. Maximum number of patients (42%) had duodenal perforation. A significant association between higher MPI scores and mortality was seen (p<0.001). Statistically, the association between APACHE II scores and mortality was significant (p<0.001).Conclusions: APACHE II had a slightly higher sensitivity as well as specificity as compared to MPI. MPI is easy to calculate but accuracy of APACHE II is more, compared to MPI.

Severe Pulmonary Arteriopathy in a Neonate with Congenital Rubella Syndrome and Patent Ductus Arteriosus

Neonates with congenital rubella syndrome (CRS) are known to have associated congenital cardiac malformations. Patent ductusarteriosus (PDA) is one the most common cardiac anomalies associated with CRS. PDA refractory to medical management andassociated with ventilatory dependence is considered for surgical ligation. However, the management of PDA can be challenging in thepresence of underlying lung disease or pulmonary vascular disease. Outcomes after closure in neonates are dependent upon age,weight, nutritional status, pre-operative pulmonary arterial hypertension and presence of chronic lung disease. We present a neonatewith CRS who required surgical PDA closure. The neonate developed severe pulmonary arterial hypertension which led to fatal outcome.The clinical course is corroborated with histo-pathological changes observed on the autopsy of this neonate.

Tricuspid stenosis: A rare and potential complication of ventricular septal occluder device

Asymmetrical septal occluder device (ASOD) has made percutaneous closure of ventricular septal defect an easy and effective management option. Although there are reports of aortic and tricuspid valvular regurgitation after deployment of ASOD, only few cases of tricuspid stenosis (TS) has been reported so far in the literature. We report a case of malaligned ASOD that occurred after successful device closure resulting in TS along with mild tricuspid and aortic regurgitation requiring surgical retrieval. Transesophageal echocardiography played crucial role in detecting the cause of tricuspid valve dysfunction besides providing continuous monitoring during the procedure. We intend to emphasize the need of echocardiographic evaluation of the tricuspid valvular apparatus and aortic valve during and after the device deployment even after the successful device closure to prevent this rare complication.

The Study Of Nutrient Foramen Of Bones Of Arm And Forearm In Adults

The variation in presence of number of nutrient foramen is important in long bones as nutrient foramen gives passage for entrance of nutrient arteries in to the bone. The present study was conducted on total 114 dry human long bones in department of anatomy, Era's lucknow medical college, lucknow. . The aim of the study was to determine the number of nutrient foramen in long bones of upper limb. Ethical approval was procured from the institutional ethical committee. In our study 97.40% humerus bones show single nutrient foramen, and 2.60% humerus bones show double NF, and all the radius and ulna show the single NF. The results of our study is similar with previous studies. The importance of knowledge about NF is very use full in orthopedic surgeries and in micro vascular bone grafting.

Ambient air pollution and impairment of lung volumes and capacities in young inhabitants of industrial area of Kanpur.

Background: Air pollution is one of the major problem faced in developing countries like India. Chronic exposure to air pollutants can leads to hampered day today activity and increased visit to clinics. The pollutant PM10 (particulate matter size less than 10 μ) especially a risk factor associated with decreased lung functions and lung growth. The effect of particulate pollution on lung functions in young ones is still lacking in India especially in Kanpur, a highly polluted city of U.P., India. Aims and Objective: The present study was conducted to evaluate the impact of chronic exposure of air pollution on lung functions in subjects of the polluted area of the city. Material and methods: One hundred twenty male subjects, in age group of 18 to 30 years from polluted and non-polluted area of Kanpur, India were participated in the study. Anthropometric data were taken. Pulmonary function test was conducted in standing position. Pollution data of study period was taken from Central pollution control board and compared with the National ambient air quality standard. Statistics: All data presented as mean ± SD and analysed by independent sample t test by using SPSS version 15. Results: The anthropometric data were statistically not significant in two areas. The Forced Vital Capacity, Forced Expiratory Volume in 1 sec, Forced Expiratory Flow 25-75% and Peak Expiratory Flow were reduced except the FEV1/FVC ratio which was not statistically significant between the groups. Conclusion: The long term exposure of pollutant PM10 could reduce the lung function. By reducing the pollution level a change in lung function and lung growth could be obtained. Thus every attempt should be made towards lowering air pollution like car pool concept, alternate fuels such as CNG or hybrid technology.

Weiss criteria in large adrenocortical tumors: A validation study.

Background: Several systems including pathologic criteria alone or in combination with clinical features have been proposed to differentiate between benign and malignant adrenocortical tumors and assess their prognosis. The Weiss system appears to be the most commonly used method for assessing malignancy but there are only a few studies which have evaluated its diagnostic power. Since we see large adrenocortical carcinoma (ACC), we attempt to evaluate the diagnostic power of Weiss system in large ACC. Materials and Methods: In this study clinicopathological characteristics of 42 adrenocortical neoplasms are studied and classified into adrenocortical adenoma (ACA) and ACC based on Weiss score of less than or equal to three or greater than three. Results: The histological criteria of Weiss appeared to predict tumor prognosis accurately. Five year survival of patients with Weiss scores of less than or equal to three was 100% compared to 0% of those with Weiss scores greater than three. The average weights of ACA and ACC were 13.0 plus/minus 8.4 grams and 621.1 plus/minus 335.2 grams respectively; average sizes of ACA and ACC were 2.8 plus/minus 1.0 cmsand 13.6 plus/minus 3.7 cms respectively. Conclusion: Weiss score was found to be a good prognostic factor for tumors of the adrenal cortex.

The external laryngeal nerve in thyroid surgery: the 'no more neglected' nerve.

AIMS: To describe a novel surgical technique of 'lateralization' of superior pole to identify and save external branch of superior laryngeal nerve (EBSLN) during thyroidectomy. SETTINGS AND DESIGN: Prospective, nonrandomized at a tertiary care hospital in a specialized unit. MATERIAL AND METHODS: Over 30 months, 46 patients underwent thyroidectomy using technique of 1) 'Lateralization' of upper pole and dissection of avascular cricothyroid space 2) identification of EBSLN 3) skeletonization and individual ligation of superior thyroid vessels. Identified nerves were classified according to Cernea's classification. Outcomes were number of nerves identified, number of 'at risk' nerves' bilateral asymmetry and incidence of injury assessed by subjective interview and indirect laryngoscopy. RESULTS: Of the 78 dissected superior poles, nerves could be identified in 72 (92.31%). There were 22 (28.2%) type I, 42 (53.54%) IIa and 8 (10.25%) IIb 'at risk' nerves. In 32 patients with bilateral dissections, asymmetry of nerve was noted in 15%. Injury to nerve was not recorded in any of the patients. Average weight of glands was 69.59 g. Thyroidectomy was performed for benign disease in 28, malignancy in 4 and thyrotoxicosis in 14 patients. CONCLUSIONS: With technique of 'lateralization' and 'skeletonization and individual ligation of the superior vessels,' EBSLN identification increases and injury can be prevented. These results relate to the utilization of specific surgical technique and it is reasonable to expect that most surgeons, once familiar with the technique, should be able to achieve similar outcomes.

Parathyroid lipoadenoma: case report and review of the literature.

Parathyroid lipoadenoma is a rare variant of parathyroid adenoma showing intermingling of chief/ oxyphil cells with abundant mature adipose cells, the latter comprising 20-90% of the tumour. Approximately thirty-five cases have been reported previously. We report a case of 41-year old woman who presented with clinical manifestations of primary hyperparathyroidism. She had elevated serum calcium and parathyroid hormone levels. Radiological investigations suggested presence of adenoma. Intra-operatively, parathyroid adenoma was found in the neck in an ectopic location behind the carotid sheath and extending into the superior mediastinum. Clinicopathological findings of this rare tumour are discussed.