ABSTRACT
Background: There is no oncologic basis for the extirpation of the submandibular gland (SMG) in early oral squamous cell carcinomas (OSCC) unless the SMG is truly infiltrated by the tumor. The study aimed at assessing the true involvement of SMG in OSCC and to determine whether the gland extirpation in all cases is justified. Methods: This study prospectively evaluated the pathological involvement of SMG by OSCC in 281 patients, who were diagnosed with OSCC and underwent wide local excision of the primary tumor with simultaneous neck dissection. Results: Among 281 patients, 29 (10%) cases underwent bilateral neck dissection. A total of 310 SMG were evaluated. Involvement of SMG was seen in 5 (1.6%) cases. SMG metastases from Level Ib were seen in 3 (0.9%) of cases, whereas 0.6% showed direct SMG infiltration from the primary tumor. The advanced floor of mouth and lower alveolus cases had a higher tendency to infiltrate SMG. In none of the cases, bilateral or contralateral SMG was involved. Conclusion: The findings of this study show that the extirpation of SMG in all cases is truly irrational. Preserving the SMG is justified in early OSCC with no nodal metastasis. However, SMG preservation is case dependent and is an individual preference. Further studies are required to assess the locoregional control rate and salivary flow rate in postradiotherapy cases where SMG is preserved.
ABSTRACT
Background: Exudative pleural effusions are a common diagnostic problem in clinical practice, as the list of causes is quite exhaustive, although sometimes they can be inferred from the clinical picture. In the West the most common cause is Para pneumonic effusions followed by malignancy, while in India it is tubercular effusion followed by malignant effusion. Despite the availability of various tests, there is a need for defining the best diagnostic and cost-effective approach to quickly diagnose and treat exudative pleural effusions. The objectives are to conduct a clinical and etiological study of exudative pleural effusion, to evaluate biochemical profile, cytological profile and radiological profiles of exudative pleural effusion.Methods: Prospective study of 100 patients with exudative pleural effusions. The demographic data was expressed as mean±standard deviation. Comparison between groups was done by Chi-Square test and Fischer exact test for categorical variables and Kruskar-Wallis and Mann-Whitney tests for continuous variables.Results: There were 67 males and 33 females. The mean age was 41.6±15.74. The majority were tubercular in origin (67%),13%,8%,3%and 6% were malignant effusions, Synpneumonic effusion, pancreatic effusions and empyema respectively. Diagnosis was not established in 3% of effusions. Massive effusions were seen in 53.8% of malignant effusions and 33.3% of empyemas. Most effusions had a total cell count between 1000 to 5000 cells /mm3.Lymphocyte predominant effusions were seen in 84.6% and 89.6% of malignant and tubercular effusions. 61.5% of malignant effusions had a positive cytology. Tubercular effusion had a pleural fluid ADA more than 40 IU/L. 92.3% of malignant effusion had pleural fluid ADA less than 30IU.Conclusions: Pleural effusion is a commonly encountered in medical practice and in our country, the commonest cause is tuberculosis, as is evidenced from the present study. The initial step in evaluating case of pleural effusion is to establish the cause of pleural effusion which is done by a detailed history, clinical examination and investigations like a chest radiology and pleural fluid analysis. Even in the advanced diagnostic approaches, still detailed clinical history and examination of the patient of the patient is important to make a clinical diagnosis. All suspected cases of pleural effusion should undergo Sonography of the thorax along with routine chest x-ray. Fluid cytology should be done to confirm tuberculosis or to rule out malignancy, which guides the physician for further evaluation of the patient if required.
ABSTRACT
Background & objectives: An outbreak of acute encephalitis syndrome (AES) among children from Nagpur division, Maharashtra was investigated to confirm the aetiology and to describe clinico-epidemiological features. Methods: AES cases among children <15 yr, from Nagpur division, hospitalized between June-September 2007, were investigated. Serum and cerebrospinal fluid (CSF) were tested for IgM antibodies against Chandipura virus (CHPV) and Japanese encephalitis virus (JEV) and for CHPV RNA by RT-PCR. Partial N gene sequences were used for phylogenetic analysis. Virus isolations were attempted in rhabdomyosarcoma (RD) cell line. Sandflies were collected, pooled and tested for CHPV RNA by RT-PCR. Results: A total of 78 AES cases were recorded in children <15 yr of age. Case fatality ratio was 43.6 per cent. Male to female ratio was 1:1.2. Chandipura (CHP) was confirmed in 39 cases. CHPV RNA was detected in both CSF and serum specimens of 2 cases and in serum of 22 cases. Phylogenetic analysis showed 99.98 – 100 per cent nucleotide identity in the sequences studied. Anti-CHPV IgM antibodies were detected in CSF of 2 cases and in serum of 8 cases. Seroconversion to anti-CHPV IgM antibodies was observed in 5 cases. Clinical manifestations of CHP cases (n=38) were fever (100%), convulsion (76.3%), altered sensorium (34.2%), headache (23.7%), vomiting (44.7%) and diarrhoea (23.7%). CHPV RNA was detected in one of two pools of sandflies from affected locality. Interpretation & conclusions: Chandipura virus was confirmed as the aetiological agent of this acute encephalitis outbreak with high case-fatality among children.