To Assess the Clinical Impact of 18F-FDG PET/CT in Non-Treated Cases of Squamous Cell Carcinoma of Head and Neck Presenting with Clinically and/or Radiologically N0 Status

Background: The most common sites are the oral cavity, pharynx and larynx and 85% to 95% neoplasms of the head and neck are SCCHN. The preservation of function, especially as it relates to speech, swallowing, and mastication, as well as cosmetic considerations, are considered essentials for determining the most effective management paradigm for SCCHN. The most common known imaging modalities in clinical use are CT and MRI imaging, despite their suboptimal sensitivity and specificity for the detection of distant metastases. The aim of present study is to establish the impact of 18F-FDG PET/CT in clinically and/or radiologically negative neck in the assessment of cervical lymph nodes. Materials & Methods: The present study was conducted in the Department of Nuclear Medicine and PET CT, Sudhamayi Hospitals and Clinics, Cochin, Kerala over a period of about one and half years. The study group comprised of untreated patients of both sexes with age ranging from 20 to 81 years referred to our department with an established tissue diagnosis of SCCHN for 18F-FDG-PET/CT Whole Body scan for evaluation of disease status and staging. 8 -10 mCi of 18F-Flouro-Deoxy-Glucose (18F-FDG) was injected I.V. in euglycemic status. Time of injection was noted along with pre-injection and post injection counts. Whole body PET/CT images (head to mid-thigh) were acquired after 45 min to 60 min post injection. Data including age, sex, endoscopy (direct / indirect) findings, neck lymph nodes level by clinical examination and radiological finding, FNAC/histopathology report of the primary and /or lymph nodes and conventional imaging (CT/MRI when available) findings was recorded. SPSS software was used for analysis. Results: At presentation, in 32.4% (n-12) of patients no nodes were palpable. Ipsilateral (single / multiple levels) lymph nodes were present in 48.7% of the patients (n-18). Bilateral involvement was seen in 18.9% (n-7) of the cases. Patient with FDG non avid necrotic lymph node was staged N0 on PET/CT but clinically had N2c disease was excluded from further analysis. There was no change in the overall stage or management of this patient. Conclusion: 18F-FDG PET/CT can accurately predict N stage better than clinical / conventional imaging leading to change in nodal staging and thus overall staging of patients. Thus it acts as a valuable tool in determining the exact nodal spread of squamous cell carcinoma and thus establishing the exact treatment plan.

Planting geometry to optimize growth and productivity in faba bean (Vicia faba L.) and soil fertility.

Faba bean (Vicia faba L.) responses to alteration of its ambient environment leads to certain modification in the crop phenology, yield attributes and economic yield. To know the extent and pattern of response by faba bean to alterations, a two year field experimentation was carried out with two crop establishment methods (i) flatbed planting (ii) raised bed planting, four planting geometry (i) 30X20 cm(ii) 30X30 cm (iii) 30X45 cm and (iv) 45X45cm and three seeding depth. All the treatment (two crop establishment methods, four planting geometry and three seeding depth) were combined together consisting twenty four treatments, were organized in factorial experiment in complete randomized block design (CRBD) with three replications. Data were recorded on growth and development; yield attributes and yield. Soil analysis was done and finally statistical tool were applied to come in to valid conclusion. Raised bed planting proves superior over flatbed in case of seed yield. Square planting architect with 30 cm apart prove better (3690.9 kg ha-1) than other tested planting geometry. Seeding at 10 cm depth showed, significant improvement in seed yield per plant and per ha over other two tested seeding depth. Phosphorus availability was significantly higher in raised bed planting (36.9 kg ha-1). However, available K (kg ha-1) was significantly influenced by planting geometry and seeding depth. It was maximum (155.2 kg ha-1) with 30X 45 cm plant geometry, proved significantly higher than 30X20 cm and 30X30 cm and at par with 45X45 cm planting.

Transient cytotoxicity of 131I beta radiation in hyperthyroid patients treated with radioactive iodine.

Background & objectives: Radioiodine (131I) or radioactive iodine in low doses is used worldwide as the first line of management in the treatment of hyperthyroidism. Information is available on the extent and severity of cell damage after a high dose radioiodine (131I) therapy for thyroid cancer, but information is scanty on its cellular effects, its extent and severity of cell damage after a low dose 131I therapy. The present investigation was aimed to study the cytotoxic effects of a low dose 131I therapy in varying doses as is normally being used in routine clinical practice in the treatment of various forms of hyperthyroidism. Methods: Peripheral blood lymphocytes were analyzed in 32 hyperthyroid patients. All of them received 131I in the form of sodium iodide solution orally. Blood lymphocytes were studied for the presence of chromosomal aberrations (CA) and micro nucleus (MN) using micronucleus assay. Blood samples of these patients were drawn prior to the treatment, on 7 thand 30 thdays after the treatment. Results: The results indicated a positive relationship between 131I dose, CA and MN frequency. A statistically significant increase in CA and MN frequency in day 7 post- therapy and a decrease in mean levels of CA and MN on day 30 post-therapy were observed when compared to pre-therapy. Interpretation & conclusions: This study showed that the cytogenetic damage induced by 131I in low doses i.e., less than 555MBq was minimal and reversible. Patients can be motivated to undertake this safe and easy procedure as a first line of therapy in the treatment of hyperthyroidism.

Tracheobronchomegaly associated tracheomalacia: analysis by sleep study.

Tracheobronchomegaly (TBM) occasionally may progress to extensive tracheomalacia which leads to respiratory failure. Spirometry, dynamic expiratory multidetector computed tomography (CT), bronchoscopy are used to diagnose patients of suspected tracheobronchomalacia. We used the technique of night-time monitoring of respiratory variables to show the presence of respiratory abnormalities during sleep and which was corrected by applying nasal continuous positive airway pressure (CPAP). The study showed the presence of both apnoea and hypopnoeas, which were obstructive in nature with an apnoea-hypopnoea index (AHI) of 11, no snoring and associated oxygen desaturation of 75 per cent. A second overnight study with nasal continuous positive airway pressure at a critical pressure of 8 cm, the AHI decreased to 3 along with no drop in oxygen saturation. This non-invasive technique should be considered as a diagnostic tool in tracheobronchomalacia and to know the outcome of CPAP, surgical or stent therapy in this condition.

Upper lobe fibrosis in ulcerative colitis.

We report a case of ulcerative colitis where chest radiograph and high-resolution computed tomography (HRCT) of the lungs revealed bilateral upper lobe fibrosis, which was misdiagnosed and treated as pulmonary tuberculosis. The diagnosis of ulcerative colitis was confirmed by sigmoidoscopy and rectal biopsy.

Transdiaphragmatic extension of hepatic hydatid cyst.

Transdiaphragmatic extension of hydatid cyst (HC) or cystic echinococcosis (CE) of the liver is a rare phenomenon. We report a case that presented as a right middle lobe consolidation. The diagnosis of transdiaphragmatic extension of hepatic hydatid cyst was suspected on CT scan of the chest and abdomen, and confirmed operatively. A successful outcome was achieved by a combination of pre- and post-operative albendazole therapy combined with surgery.

Flour mill lung: a pneumoconiosis of mixed aetiology.

We report two cases of mixed dust fibrosis which occurred in the setting of poorly ventilated flour mills where various kinds of grain, chiefly wheat, were ground using stones whose silica content was analysed to be greater than 80 percent. While one patient was a non-smoker and the other was an ex-smoker, both cooked on kerosene stoves in the same room. We propose the term 'Flour mill lung' for this form of pneumoconiosis. A larger study would be required to establish the entity and its incidence among flour mill workers.

Non responding pneumonia with skin lesions.

Sweet's syndrome (acute febrile neutrophilic dermatitis) is characterised by classical skin lesions accompanied by fever and malaise. Systemic involvement may be present and lung involvement in Sweet's syndrome has been reported in the form of bilateral pulmonary infiltrates, bronchiolitis obliterans organising pneumonia and pleural effusion. There are dense papillary neutrophilic infiltrates on histopathology. We present a case of Sweets' syndrome with left lower lobe consolidation and persistent fever which was non-responsive to antibiotics but showed clinical improvement with clearing of radiological opacities on oral steroid therapy.

Giant cell pneumonitis induced by cobalt.

Cobalt alone and in combination with tungsten carbide known as hard metal is capable of causing lung damage. This may vary from development of pulmonary oedema to asthma and fibrosing alveolitis. We report a case of giant cell interstitial pneumonitis caused by exposure to cobalt dust which was not identified as the etiological agent initially and hence led to progression of the disease. The patient subsequently improved following cessation of exposure and treatment with oral corticosteriods, thereby stressing the importance of occupational history in all cases of interstitial pulmonary fibrosis.

Recurrent respiratory papillomatosis.

Recurrent respiratory papillomatosis is characterized by the appearance of benign laryngeal squamous papillomas in childhood. Lung involvement is rare. We report a case of childhood laryngeal papillomas who developed tracheobronchial papillomas and a nodule in the lung after a period of 21 years. Frequent sampling of pulmonary lesions to detect malignant transformation is suggested as prognosis of lung lesions are worse in comparison to laryngeal papillomas.

A high rate of caesarean sections in an affluent section of Chennai: is it cause for concern?

BACKGROUND: While rising Caesarean section rates have been the subject of much attention and debate worldwide, there is not much information available on this rate and its potential adverse impact in India. METHODS: Our survey was a standard Expanded Programme on Immunization 30-cluster design, carried out in an urban educated, middle/upper class population in Chennai. Mothers of 210 children aged 12-36 months were interviewed and data collected on immunization and breast-feeding practices. Since the mode of delivery was one of the questions, we could generate population-based data on the Caesarean section rate and its influence on breast-feeding. RESULTS: Of the 210 babies, 95 (45%, 95% confidence interval: 39.1-51.3) had been delivered by Caesarean section. Two hundred and six of 210 babies (98%) had been breast-fed at some time. However, babies born by Caesarean section tended to be started late on breast-feeds were given prelacteal feeds more often, and colostrum less often when compared to babies delivered vaginally (all statistically significant). CONCLUSIONS: Our study revealed a very high rate of Caesarean section in the selected metropolitan population. On purely scientific grounds, a rate of 40% to 50% is extremely difficult to justify. Though not conclusive, the data also suggest that Caesarean section may be adversely affecting some aspects of breast-feeding. There is a need for more data and audits on Caesarean section rates in India, and a wider debate on its potential adverse impact on the health of mothers and newborns.

Trigeminal evoked potentials in patients with symptomatic trigeminal neuralgia due to intracranial mass lesions.

Trigeminal evoked potentials (TEP) were recorded by electrical stimulation of the lips in 7 patients with symptomatic trigeminal neuralgia due to CT proved mass lesions involving the trigeminal nerve. All the patients showed TEP abnormalities on the affected side. Chronic compression and irritation of the trigeminal nerve may be responsible for these changes. The results obtained were compared with other similar studies and TEP abnormalities observed in idiopathic trigeminal neuralgia. As all the patients had unequivocal compression of the trigeminal nerve and all of them had TEP changes, it can be concluded that TEP abnormality is an accurate predictor of trigeminal nerve compression. TEPs may be a valuable aid in demonstrating a compressive element in patients with trigeminal neuralgia.

Flow volume loops: postural significance.

Upper airway obstruction is an important but often unrecognised cause of dyspnoea and ventilatory failure. Flow volume loop remains the most sensitive method to detect upper airway obstruction. We report a patient with Hashimoto's thyroiditis who showed evidence of upper airway obstruction on the flow volume loop only in the supine position. It is important to recognise as it may be missed during the conventional method of performing a pulmonary function test in sitting posture and also because surgical intervention should be considered in patients with tracheoesophageal compression due to a thyroid swelling.