Transoral endoscopic excision of cystic hygroma vestibular approach in adult (novel approach): a case report

Lymphangioma, soft tissue tumor was originally reported by R. Backer in 1828 and “cystic hygroma” name was first given by Wernker in 1834. It can occur in the head, neck, axilla, cervico-facial regions and below tongue. Although it is well recognized in children, it may present in adulthood. Cystic hygroma neck is traditionally removed via an overlying incision near or over the swelling. The resultant scar can be displeasing to an adult. Various endoscopic approach present in literature for excision are via neck, anterior chest, combined or robotic assisted. We here, are reporting transoral endoscope excision of cystic hygroma via vestibular approach. A 51 year old female with swelling over anterior aspect of neck, trans-illumination positive, diagnosis confirmed on CT neck, of size ~4×4 cm was our case. We decided for transoral endoscopic vestibular approach for excision, first of its kind with no assisted approach. Patient discharged after 3 post-operative days (PODs). There was mild seroma which resolved within a week. Transoral endoscopic excision of cystic hygroma via vestibular approach without any assisted approach can be applied in adult. Various approach present in literature for excision of cystic hygroma are via neck, anterior chest or combined or robotic assisted. Hence this approach can be an excellent choice for adult cystic hygroma patients who desire to avoid a neck incision. Transoral endoscopic excision of cystic hygroma via vestibular approach was successfully performed. Patient was satisfied with good cosmosis. It results in good cosmesis and better dissection. Hence can be a new method of excision of cystic hygroma in adult.

Ultra-widefield fundus fluorescein angiography in pediatric retinal vascular diseases

Purpose: To describe the utility of RetCam ultra-wide-field fundus fluorescein angiography in pediatric retinal vascular diseases. Methods: A retrospective chart review was carried out in 43 eyes of 22 pediatric patients who were diagnosed or suspected to have a retinal vascular disease. Fluorescein angiography was carried out using the 130 degree lens of RetCam 3. Fluorescein angiography guided treatment (laser/cryotherapy) was carried out wherever required. Results: Diseases studied included - coats disease, familial exudative vitreoretinopathy, retinopathy of prematurity, congenital retinal folds, double optic nerve head, persistent fetal vasculature and incontinentia pigmenti. RetCam assisted fluorescein angiography was helpful in establishing a diagnosis in 4 patients (18%), in decision making regarding treatment in 18 patients (82%), in deciding need for retreatment in 5 patients (23%), helped in staging of disease in 5 patients (23%) and in detecting clinically subtle findings in 6 patients (27%). Conclusion: RetCam assisted FFA is extremely useful to document peripheral retinal vascular pathologies in pediatric patients and helps to take crucial therapeutic and retreatment decisions.

Modified silicone sling assisted temporalis muscle transfer in the management of lagophthalmos.

Aim: To evaluate the efficacy of modified temporalis muscle transfer (TMT) by silicone sling for the management of paralytic lagophthalmos. Settings and Design: Prospective interventional study. Materials and Methods: Ten patients of lagophthalmos due to facial palsy underwent modified TMT using silicone sling. The patients were followed‑up for a period of 3 months. Palpebral aperture in primary gaze and during eye closure were assessed both pre‑ and postoperatively along with problems associated with lagophthalmos like exposure keratopathy and lacrimation. Statistical Analysis: Paired t‑test was applied to measure the statistical outcome. Results: Eight patients achieved full correction of lagophthalmos with no lid gap on closing the eye. The mean (standard deviation (SD)) lid gap on eye closure was 7.7 (0.86) mm preoperatively, 0.5 (0.47) mm at 1st postoperative day, and 0.7 (0.75) mm at 3rd month. There was a reduction in mean lid gap on eye closure of 7 mm at 3 months (P < 0.0001) which is highly significant. The mean (SD) vertical interpalpebral distance during primary gaze was 12.05 (1.12) mm preoperatively, 10 (0.94) mm at 1st postoperative day, and 10.35 (1.08) mm at 3rd month. There was a reduction in mean vertical inter palpebral distance of 1.7 mm at 3 months (P = 0.001) which is significant. Exposure keratitis decreased in five out of six patients at 3 months. Conclusion: Modified TMT by silicone sling is a useful procedure with lesser morbidity and good outcomes for the treatment of paralytic lagophthalmos due to long standing facial palsy.

Characterization of different verrucous mucosal lesions.

Oral lesions indicative of biopsy represent unique presentation either in the form of proliferations/ulcerations of the squamous lining epithelium. These lesions have similar appearance clinically and histopathologically hence are excised for microscopic evaluation to rule out early or hidden malignancy. Verrucous mucosal lesions clinically present a diagnostic dilemma, which makes histopathological examination a significant one in the differentiation of the lesion to ascertain the nature. This short communication aims to discuss the different histological characterization of oral verrucous mucosal lesions.

Remote sensing and GIS based forest cover change detection study in Kalrayan hills, Tamil Nadu.

The present study focuses on the role of remote sensing and geographic information system (GIS) in assessment of changes in forest cover, between 1931 and 2001, in the Kalrayan hills, Tamil Nadu. The trend of forest cover changes over the time span of 70 years, was precisely analysed using high resolution Satellite data. The study revealed that the forest cover was 275.6, 481.7 and 266.5 sq.km in 1931, 1971 and 2001 respectively. It was noticed that forest cover has increased between 1931 and 1971, because of the implementation of various afforestation schemes by the forest department and scared grooves. It also revealed that the forest cover loss between 1971 and 2001 could be due to Shifting cultivation and illegal encroachments by villagers; and the forest cover drastically decreased on plateau areas due to human population pressure. The study analyses the forest cover change in the tropical deciduous forest region of the Eastern Ghats of India. It is envisaged that the study would prove the usefulness of Remote Sensing and GIS in forest restoration planning.

Small Vessel Disease and Subcortical Vascular Dementia

Atherothromboembolism and intracranial small vessel disease are considered to be the main causes of cerebrovascular injury, which may lead to cognitive impairment and vascular dementia (VaD). VaD appears to be the second most common type of dementia with prevalence estimates of 10-15%. Cortical or multi-infarct dementia and subcortical vascular dementia (SVD) are suggested to be the two main forms of VaD. The main clinical features of SVD comprise decreased motor performance, early impairment of attention and executive function with slowing of information processing. SVD results from lacunar infarcts or multiple microinfarcts in the basal ganglia, thalamus, brainstem and white matter and are associated with more than 50% of the VaD cases. White matter changes including regions of incomplete infarction are usually widespread in VaD but their contribution to impairment of subcortical regions is unclear. While most of VaD occurs sporadically only a small proportion of cases bear clear familial traits. CADASIL is likely the most common form of hereditary VaD, which arises from subcortical arteriopathy. SVD needs unambiguous definition to impact on preventative and treatment strategies, and critical for selective recruitment to clinical trials.

Theophylline clearance in undernourished asthma patients.

Theophylline clearance is altered by many drugs and diseases that may be associated with undernutrition. Therefore, we studied theophylline clearance in 12 undernourished [body mass index (BMI) less than 19] and 12 well nourished asthma patients (body mass index more than 19). Uncoated theophylline tablet (200 mg, 300 mg dose 5 mg/kg approx) was administered orally to each asthma patient after 12 hours overnight fasting. Serum theophylline concentrations were estimated after 2, 4, 6, 8 hours of drug administration and it was calculated from log conc: time curve. Undernourished asthma patients had a mean theophylline clearance of 85.6 (SE = 6.2) ml/hr/kg while it was 125.6 (SE = 3.8) ml/hr/kg in well-nourished asthma patients. The difference between two groups was highly significant (p < 0.01). We conclude that theophylline clearance is significantly lower in undernourished asthma patients and they will require a lower maintenance dose of theophylline.

Intersubject variability of serum theophylline concentration after single dose of uncoated controlled release theophylline tablet administration in asthmatic patients.

Various reports indicate significant intersubject variation in the rate of absorption of controlled release theophylline products that are commercially available. Serum theophylline concentration was estimated in 17 asthma patients treated with controlled release theophylline tablet (mean dose: 5.6 +/- 0.6 mg/kg, mean body wt: 49.82 +/- 9.05 kg). The mean maximal concentration (Cmax) of 5.57 +/- 1.65 micrograms/ml occurred at mean time of maximal concentration (Tmax) of 3.3 +/- 1.36 (mean +/- SD) hours. Mean minimal concentration (Cmin) was 3.164 +/- 1.1 micrograms/ml (mean +/- SD) at mean time of minimal concentration (Tmin) of 5.77 +/- 1.77 (mean +/- SD) hours. The mean percent fluctuation was 112.95 +/- 183.45 (mean +/- SD) but in 4 out of 17 patients, percent fluctuation was 107.29 to 823.10. Therefore, 23.5% patients treated with controlled release theophylline tablet had wide fluctuations in serum theophylline concentration.