Comparision of efficacy of levocetirizine with montelukast and levocetirizine alone in persistent allergic rhinitis

To compare the efficacy of levocetirizine with montelukast and levocetirizine alone in patients with persistent allergic rhinitis in our setup. Patients with symptoms of AR attending ENT clinic were registered and divided into two groups based on drug given. Patients with odd numbers were included in group A receiving levocetirizine 5mg with montelukast 10mg once daily while patients with even numbers were included in group B receiving only levocetirizine 5mg once daily. Data was collected at visit 1 prior to medication, visit 2 one week after medication and visit 3 two weeks after medication. Medication history review, nasal symptom assessment and anterior rhinoscopy were done at each visit. Patients were evaluated for rhinorrhea, sneezing, nasal itching and nasal obstruction on a scale. Total symptom complex score [TSCS] was calculated by adding scores of all four variables under study using proforma. Lower the score more effective will be the drug. One hundred twenty four patients were included in study; 63 were male and 61 were female. TSCS was 9 -10 in 73.3% patients at visit 1 in levocetirizine + montelukast group that improved to 4-5 in 28.3% and 3- 4 in 65% patients at visit 2 and 3 respectively. Patients receiving levocetirizine alone had TSCS of 9 to 10 in 52.9% at visit 1 with an improvement to 3-4 in 9.4% and 49.1% at visit 2 and visit 3 respectively. Levocetirizine with montelukast is superior to levocetirizine alone in controlling overall symptoms of AR.

Comparision of efficacy of levocetirizine and fexofenadine in patients with symptomatic allergic rhinitis

To compare efficacy of levocetirizine 5mg and fexofenadine 120mg in once daily dosage in patients with symptomatic allergic rhinitis. Quasi experimental study. Pakistan Institute of Medical Sciences, Islamabad from 5th July 2007 to 5th July 2008. Patients with symptoms of AR attending ENT clinic were registered and divided into two groups based on drug given. Patients in group A were given levocetirizine while patients in group B were given fexofenadine. Data was collected at visit 1 prior to medication, visit 2 one week after medication and visit 3 two weeks after medication. Medication history review, nasal symptom assessment and anterior rhinoscopy were done at each visit. Patients were evaluated for rhinorrhea, sneezing and nasal obstruction on a scale. Total symptom complex score [TSCS] was calculated by adding scores of all three variables under study using proforma. RESULTS: 106 patients were included in study; 62 male and 44 female. TSCS was 9-10 in 73.3% patients at visit 1 in levocetirizine group that improved to 4-5 in 28.3% and 3-4 in 65% patients at visit 2 and 3 respectively. Patients receiving fexofenadine had TSCS of 9 to 10 in 52.9% at visit 1 with an improvement to 3 - 4 in 9.4% and 49.1% at visit 2 and visit 3 respectively. Levocetirizine is superior to fexofenadine in controlling overall symptoms of AR in our study

Occult metastasis in carcinoma of oral cavity

To determine the frequency of occult neck node metastasis in squamous cell carcinoma of oral cavity, in particular relation to the subsite and histopathological grading, and of involvement of the level of lymph nodes in the neck in oral cavity carcinoma. Descriptive study. Pakistan Institute of Medical Sciences, Islamabad and Wah Medical College, POP Hospital, Wah Cantt. from June 2000 to August 2006. Inclusion criteria were untreated carcinoma of oral cavity, not crossing midline, having NO neck. The tumors size more than T4 were excluded. All patients had ipsilateral type III modified radical [functional] neck dissection and lymph node groups were subjected to histopathology. Occult metastasis were found in 12 out of 37 cases [32.4%]. Metastasis in tongue carcinoma was 5/14, lower afveofar ridge carcinoma metastasized in 5/18, floor of mouth carcinoma was 2/4 and buccal mucosa carcinoma was 0/1.The percentage of occult metastasis in well-differentiated carcinoma [WDSCC], moderately differentiated carcinoma [MDSCC], and poorly differentiated carcinoma [PDSCC] were 22.2, 25% and 54.6% respectively. The levels of lymph nodes involved were level I [16.7%], level II [83.3%], level III [75.5%] and level IV [16.7%]. Oral cavity is a favourable site for metastasis to lymphatics even with small tumors. Occult metastasis is so frequent even with early carcinomas that neck should be treated with primary site. It is also important to remove level IV lymph nodes along with level I, II and III

Management of parapharyngeal space tumours

To determine the role of clinical features, fine needle aspiration cytology [FNAC] and computed tomography [CT] scan in diagnosing parapharyngeal space [PPS] tumors and treatment options. A descriptive study. From July 2000 to July 2002 at Pakistan Institute of Medical Sciences, Islamabad. Patients diagnosed as having PPS tumors were studied. The medical record of patients was reviewed for their age, gender, clinical features, investigations [FNAC and CT scan] and treatment. The mean age, percentage of different clinical features and the sensitivity and specificity of FNAC was determined. The mean age of patients presenting with PPS tumours was 33.6 years. The most common clinical features were neck mass [93%] and bulge in lateral pharyngeal wall [80%]. The CT scan showed exact location and extent of tumour in 11 out of 15 cases. The sensitivity and specificity of FNAC was 70% and 85% respectively. The most common tumours were neurogenic tumours [6] and salivary gland tumours [4]. Surgery was performed in all except 2 patients with lymphoma in whom radiation and chemotherapy was recommended. This study indicates that PPS tumours are usually benign neurogenous and salivary gland tumours presenting with neck mass and bulge in oropharynx. FNAC and CT scan are important in diagnostic work up and treatment planning. Surgery has the best results in most cases

Prevalence of verrucous carcinoma in laryngeal cancers and their metastatic potential

To study the frequency of: [1] Verrucous carcinoma in malignant laryngeal tumours [2] Lymph node metastasis in patients with laryngeal verrucous carcinoma. Descriptive study. Purposive type. Department of ENT and head and neck surgery, Pakistan institute of medical sciences, Islamabad. Period of study extended from 1St January 2001 to 31st December 2003. Frequency of verrucous carcinoma was evaluated among One hundred and twenty, [120] cases of malignant laryngeal tumours presented and primarily diagnosed in our ENT department. Cases of verrucous carcinoma were also evaluated for presence or absence of lymph node metastasis. Frequency of verrucous carcinoma in malignant laryngeal tumours was 2.5%. None of these patients had palpable lymph nodes at the time of presentation. Verrucous carcinoma in our population is relatively uncommon disease. Lymph node involvement is rare even with advanced t umours

Association of smoking with lymph node metastasis in early stages of squamous cell carcinoma of tongue

To determine the relationship of lymph node metastasis with smoking in T1 and T2 staged squamous cell carcinoma [SCC] of tongue. An analytical study. ENT Department of Pakistan Institute of Medical Sciences, Islamabad, from 1st January 2001 to 31st December 2002. A total of 60 patients of T1 and T2 of SCC of oral tongue were selected. These patients were divided into two groups on the basis of history of smoking. Also these patients were clinically examined for lymph node metastasis and FNAC done for the confirmation of diagnosis. Odds ratio [OR] and p-value were statistically determined to asses the association between lymph node metastasis and smoking. The odds ratio for patients with history of smoking to develop lymph node metastasis was 1.896 but association was statistically insignificant [p = 0.24]. This study indicates that although smoking increases the risk for lymph node metastasis but the association is insignificant in T1 and T2 staged SCC of tongue

Thyroid malignancies at unusual sites

Four cases of thyroid malignancy at unusual sites in the head and neck are described. Two cases of carcinoma developed in ectopic midline thyroid remnants viz a thyroglossal cyst and in a lingual thyroid. The remaining two cases were metastatic follicular carcinomata from thyroid to buccal mucosa not previously reported in the literature

Laryngotracheal reconstruction in adults: experience at PIMS

The surgical experience gained at Pakistan Institute of Medical Sciences Islamabad in the management of patients with injuries to the larynx including those with tracheal stenosis form the basis of this study. The surgical techniques, pitfalls and causes of failure are discussed in a total of 10 cases requiring surgical intervention